tailieunhanh - Manual Endourology - part 6

Dự trữ khối u trên các mái vòm bàng quang và bức tường phía trước cuối cùng. ▬ Cắt mái vòm bàng quang và bức tường phía trước có thể được hỗ trợ bởi áp lực suprapubic với bàn tay thứ hai. ▬ Sau khi cắt bỏ hoàn thành của một tổn thương, đảm bảo đông máu hoàn hảo trước khi bắt đầu với cắt bỏ tổn thương tiếp theo. | 58 Chapter 7 Transurethral Resection of Bladder Tumours Reserve tumours on the bladder dome and anterior wall for the end. Resection on bladder dome and anterior wall can be facilitated by suprapubic pressure with the second hand. After completed resection of one lesion ensure perfect coagulation before starting with resection of the next lesion. Tricks Using the shaft or the irrigation flow the lesion can be inclined backwards. The angle between the bladder wall and lesion increases and therefore the resection is much easier. Using a resectoscope with a short beak shaft facilitates the inclination of the tumour guaranteeing optimal vision. En Bloc Resection according to Mauermayer 1981 Use a straight loop. Cutting power is reduced to 60 W. A circular coagulation mark at a distance of 5 mm from the tumour pedicle is set around the lesion. At this mark an incision in the bladder wall is made to arrive at the deep muscular layer. By stepwise cutting the bladder wall cuff is isolated. Completion of the resection. The tumour is retrieved using a syringe. Careful coagulation of the tumour ground with a roller ball electrode. Limits Only papillary tumours with a diameter of not more than cm can be removed using this technique. Never use this technique in the bladder dome and anterior wall. Tumours in a diverticulum cannot be managed with this technique. Risks On the posterior circumference the coagulation mark is difficult to identify during cutting. Check repeatedly. Lesions larger than 3 cm in diameter cannot be retrieved. Bladder Mapping If a negative cystoscopy is in contrast to a positive cytology a bioptical evaluation of the bladder is mandatory. A cold biopsy forceps is inserted through the 24-Fr sheath. On filling half of the bladder the branches of the forceps are opened. With gentle pressure to the bladder wall the branches are put on the mucosa. The branches are closed and the closing mechanism on the bottom of the sheath is opened and the forceps .