Post-operative Diagnosis: Bladder clot, extensive papillary bladder tumor over right lateral wall anterior bladder wall and posterior bladder wall, prostatic congestion with bladder outlet obstruction

Procedure: TRANSURETHRAL RESECTION BLADDER TUMOR, FULGARATION OF PROSTATE, CLOT EVACUATION (N/A)

CYSTOSCOPY;BILATERAL RETROGRADE PYELOGRAM (Bilateral)

Findings: 1. Occluding prostate with friable prostate congestion 2. Extensive papillary bladder tumor covering the right lateral wall, anterior bladder wall and posterior bladder wall 3. Bladder clot for. Normal retrogrades

Complications: None, patient tolerated the procedure well.

Summary: Patient was taken to the operating room where he was induced under general anesthesia prepped and draped in a sterile fashion over the genitalia in the dorsal lithotomy position.

Urethra was calibrated with Otis bulb to 28 French without resistance. A 26 French Olympus continuous flow resectoscope sheath with the visual obturator was passed into the bladder under direct visualization.. Findings are as noted above. Orifices were orthotopic with no bloody efflux noted.

Clot was irrigated from the bladder with the bowl evacuator.

Continuous flow resectoscope with a bladder loop was placed into the sheath The prostatic urethra was fulgurated to control bleeding from prominent superficial vessels.

All identifiable papillary bladder tumor was resected from the bladder wall along the the lateral wall on the right, the posterior wall and the anterior wall as encountered. no perforation grossly was encountered. Air bubble remained intact throughout the course of procedure. Margins of resection and base of resected areas were fulgurated

Resected bladder wall/tumor was retrieved with a bowl of evacuator and sent to pathology.

Bilateral retrogrades were shot using a 5 French open-ended catheter. Upper tracts were normal. No filling defects obstruction or stones were noted.

Upon completion there was no active bleeding the instruments were removed and the bladder was drained with a 20 French 3 way Foley catheter passed with the aid of a catheter guide. 30 milliliters of sterile water was placed into the balloon. Return was clear on hand irrigation. The patient was awakened and sent to recovery room stable condition with clear return on CBI.

Estimated Blood Loss: 200 ml clot. Negligible blood loss with bladder tumor resection

Total IV Fluids: See Anesthesia Record

Urine Output: See Anesthesia Record

Specimen(s): Resected bladder tumor