Dr. med. Dirk Manski



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Transurethral resection of the bladder (TURB)

Review literature: (Collado et al, 2000).

Indications for transurethral resection of the bladder (TURB)

Surgical Technique of Transurethral Bladder Resection

Perioperative antibiotic prophylaxis

TURB should be done with sterile urine, any infection should treated with a full course of antibiotics. A perioperative antibiotic prophylaxis is often given, randomized studies for TURB are missing. Dosage is e.g. ciprofloxacin 500 mg p.o. 1-0-1 (for one day). Patients with risk factors for a urinary tract infection (diabetes, bladder stones and preoperative bladder catheter) benefit especially from an antibiotic prophylaxis. A perioperative antibiotic prophylaxis may reduce postoperative urinary tract infections, fever and may reduce the likelihood for urethral strictures.

Preoperative Preparations

The patient is placed in lithotomy position. Disinfect the external genitalia, the lower abdomen and the perineum and sterile draping. Spinal anesthesia or general anesthesia is needed for TURB. Spinal anesthesia offers theoretical advantages for the initial postoperative period: the patient is calm, the manipulation of the catheter is possible without pain, less pressing and coughing. General anesthesia with muscle relaxation eliminates the risk of an obturator reflex (see complications) and is preferable in lateral tumors.

Cystoscopy

Check for the width of the urethra, search for urethral tumors. The mucosa of the bladder (and prostate) is examined to identify all flat and papillary tumors.

Transurethral resection of the bladder (TURB)

fig1: TURB transurethral resection of bladder tumor

TURB: resection loop at the base of papillary bladder tumor (histology: Ta low grade bladder cancer).

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fig2: TURB resection loop

TURB of a solid bladder tumor (histology: T1 high grade bladder cancer)

TURB: Postoperative Management

Early instillation of Mitomycin C:

Irrigation catheter:

Irrigation prevents clot formation and may reduce the risk of tumor recurrence. Remove the catheter after 1–3 days, depending on the depth of the resection and postoperative bleeding.

Complications of transurethral resection of the bladder (TURB)







Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



References

Collado, A.; Chechile, G. E.; Salvador, J. & Vicente, J.
Early complications of endoscopic treatment for superficial bladder tumors
J Urol, 2000, 164, 1529-32


  Deutsche Version: Transurethrale Resektion der Harnblase (TURB)