John J. Bauer, M.D.
Risks and Complications
Detailed Surgery Description
Family waiting instructions
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This procedure is used to remove bladder tumors from the inside of the bladder. It is performed using a resectoscope, which is a specialized telescope that allows the urologist to place instruments in the bladder to coagulate biopsy or resect bladder lesions. The procedure is done through the urethra. The patient can request spinal or general anesthesia for the procedure.
Your pre-operative appointments
Before your surgery, you will be seen by the physician and the anesthesiologist, and when applicable, there is a pre-admission appointment with the hospital. Click here to read more details about these appointments, referred to as the Pre-Operative Work-Up.
Change In Health Status
Notify your surgeon if you experience any significant change in your health status: develop a cold, influenza, a bladder infection, diarrhea, or other infection, before your surgery.
Pre-Operative Medication Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery:
As injury to the bowel is unlikely in this procedure, you will have the simplest form of a bowel preparation, described below.
Pre-Operative Diet Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery:
Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist.
Pre-Operative Cleaning Instructions (bathing and showering instructions)
Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows:
On The Day Of Surgery
The anesthesiologist will discuss with you the anesthetic most appropriate for your medical condition and procedure prior to surgery.
After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs.
Time To Arrive For Your Surgery
During your Pre-Admission Interview, our Registered Nurse will provide you with the correct time to arrive for check-in prior to your surgery.
WHERE TO ARRIVE:
Risks and Complications
The risks and complications for this surgery are described in the "Counseling and Pre-Op Note" that you will need to sign before the surgery. The main content of that note is listed below.
Patient is a male with irrative bladder symptoms, micro/gross hematuria found to have a bladder tumor on a previous cystoscopy or positive voiding cytologies consistent with cancer.
Alternatives to the procedure are watchful waiting with expectant management and intravesical chemotherapy. The patient is aware that the most reliable diagnostic and curative option is surgery.
The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures, deep venous thrombosis, pulmonary embolus, myocardial infarction, heart failure, stroke, death or a long-term stay in the Intensive Care Unit (ICU). Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal head-ache, nerve damage, spinal canal bleeding and malignant hyperthermia. Your anesthesiologist will discuss the risks and complications in more depth separately. Additional procedures may be necessary.
The specific risks of this procedure include, but are not limited to: injury to or perforation of prostate capsule or bladder, ureteral injury or obstruction, additional procedures to correct injury (stent, percutaneous renal drainage), urinary tract infection, pyelonephritis, irrative voiding symptoms, incontinence, gross hematuria, clot retention, may require prolonged catheterization or recatheterization, inability to remove all the cancer, inability to get bladder muscle tissue in the specimen for accurate staging, repeat procedures may need to be performed, recurrence of cancer is possible, bladder neck contracture, and erectile dysfunction.
You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.
To view the actual printable form for this surgery, click here: Counseling Note for Transurethral Resection of Bladder Tumor. To print the document, simply select print after you have opened the page. You can use that copy to sign before your surgery.
Detailed Surgery Description
Indications: Patient was noted to have a bladder lesion on cystoscopy.
Sample Procedure Dictation:
The patient was given general anesthesia/spinal anesthesia, placed in the dorsal lithotomy position and then prepped and draped in the usual standard sterile manner. The urethral meatus and urethra was sequentially dilated to 30 French size with Hagrow urethral dilators. A 27.6 French sheath and obturator was placed gently into the urethra and bladder. The bladder was drained of urine and a cystoscopy was preformed to inspect the bladder. The bladder tumor/tumors was/were noted in the ______________________ position in the bladder.
Prior to resection a systematic mucosal biopsy of the bladder and urethra was performed. Cold cup biopsies from the dome, R/L posterior wall, R/L lateral wall, trigone and urethral were obtained. After completing these biopsies, the resectoscope was replaced through the sheath and the areas were coagulated until no bleeding was noted.
Using the resectoscope, the bladder tumor/tumors was/were resected using a standard hot loop using cutting and coagulation power settings. The bed and the outside rim of normal appearing mucosa were coagulated to prevent bleeding. Any obvious bleeders were directly coagulated. The resectoscope loop was removed and the bladder was irrigated for bladder tumor chips. The resectoscope was replaced and direct visual confirmation was made that all chips were removed and that the bladder resection site/sites and/or biopsy sites were not actively bleeding. The chips were then sent for pathological evaluation. The bladder was filled with fluid and then sheath and resectoscope was removed. A 24 French hematuria catheter was placed and clear to light rose urine effluent was noticed. The catheter was secured to the leg. CBI was initiated at 200cc per/hour.
Patient was then awaken from anesthesia without complications and transferred to the Recovery Room (RR). The patient arrived to the RR in stable condition and without complications.
Family Waiting Instructions
To the family and friends of patients undergoing surgery.
SCHEDULED STARTING TIME OF SURGERY:
ESTIMATED LENGTH OF SURGERY:
You should plan to check in at the waiting area information desk as soon as your family member or friend has left for the Operating Room. This is the only way we can talk to you afterwards, or on occasion; reach you to give you updates on the operation's progress. If the surgery is scheduled for many hours, you can leave to eat or do other things, but you should let the information desk know that you are going to leave the area, where you are going, and how long you might be gone so that we might reach you if need be. You should be in the area before the elected time of the end of the operation.
The information deck will overhead page you or the "family of" when they receive the recovery call to let you know that the surgery has been completed. The overhead page system works ONLY on the Surgical Waiting Area and not throughout the hospital or the cafeteria.
We will plan to see you in the surgical waiting area after we have safely completed the early phases of the post-anesthesia recovery in the "Recovery Room" or PAR (Post Anesthesia Recovery). This may take up to an hour after the initial call. Sometimes, especially if another case is ready to start, we will call and talk to you. If for some reason, we have not come or called within 30 minutes, please ask the information desk to page us.
Your family member will be in the Recovery Room for 1-2 hours. This is standard recovery time, although the times vary with each individual. For example, spinal anesthetics take longer to "wear off," local anesthetics are much shorter acting. Under no circumstances are family members or friends allowed in the recovery room. The information deck will inform you of the patient's return to the room as soon as they receive the information that the patient has left recovery. At that time, they will give you the room number and direct you to the correct wing and floor.
Special Instructions for Endoscopic Procedures
Circumcisions, Penile or Scrotal Surgeries
Special Instructions for Patients with Catheters
Contacting Your Physician
Dr. Bauer can be contacted by calling the number at the top of this page. You may also call the hospital to have them contact us. Please do not hesitate to call with any questions or concerns.
Frequently Asked Questions after surgery
This section is under construction.