Problems encountered during bladder cancer transurethral resection

Bladder cancer is a relatively common malignant tumor. When a patient is diagnosed with bladder cancer, the doctor will recommend transurethral resection to some patients after comprehensive consideration. However, in order to ensure that the transurethral resection of bladder cancer can be carried out smoothly, it is necessary to understand in advance what problems will be encountered in the bladder cancer surgery.

1. Urethral stenosis

When urethral stricture is encountered, if electrosurgical resection is still considered, perineal external urethrotomy can be performed. External urethrotomy, like suprapubic cystostomy, is simple and easy to perform with very few complications.

2. Tumor location

Regardless of where the tumor is located, as long as a resectoscope can be inserted into the bladder and the tumor is superficial, it is possible to remove the tumor through the urethra. Only tumors within the bladder cannot be removed by resection and must be treated with other surgical methods.

(1) Pay attention to the ureteral orifices: The most common location for bladder tumors is outside and above the two ureteral orifices. When the tumor grows larger and its base extends, the tumor may cover the ureteral orifices. Tumors in this area are easiest to electroresection, but it is inevitable that the ureter will be cut. This does not mean that stenosis will occur, but it often causes reflux.

(2) Anterior wall tumors: The most difficult bladder tumor to treat is in front of the bladder neck in men. Most tumors located here are hidden behind the pubic symphysis. The surgeon should personally apply pressure to the suprapubic area to make the tumor sag to the electrosurgical resection loop. Sometimes, lowering the operating table head can also help with the surgery.

(3) Cystocele: For tumors located at the cystocele site, the tumor can be lifted to the resection loop of the resectoscope with the help of fingers in the vagina.

(4) Tumors at the base of the bladder: Tumors located at the base of the bladder can be removed by swinging the front edge of the resectoscope up and down.

3. Bleeding

Arterial bleeding in papillary tumors is often difficult to stop with electrocoagulation. The tumor part where the bleeding is coming from needs to be electrocuted to the bladder wall, and the artery is electrocoagulated there.

4. Obturator nerve twitch

Sometimes, when a tumor on the posterior bladder wall is being electrocauterized, the thigh on the same side may twitch inward. This alarm is caused by contraction of the adductor vastus muscle as the obturator nerve is stimulated by the coagulation current. At the first sign of obturator nerve twitching, electrocautery in this area should be stopped immediately, otherwise the bladder wall may be perforated during spasm. This obturator nerve twitch can be completely eliminated by the anesthesiologist by giving intravenous choline chloride succinate, a short-acting, depolarizing muscle relaxant that blocks the conduction of nerve impulses at the myoneural junction. Curare is ineffective. Local blockade can also block the obturator nerve.

5. Bladder perforation

When a recurrent tumor in a certain area of ​​the bladder is repeatedly and deeply incised, the fat around the bladder may eventually become visible, indicating that perforation has occurred. The key is for the surgeon to be able to recognize bladder perforation. When a flash of fat tissue is seen deep in the electroresection, the electroresection of this area should be stopped immediately. The bladder should be drained with a catheter and kept open to prevent urine extravasation. If the perforation is extra-abdominal, in addition to adequately draining the bladder, attention should also be paid to hemostasis to prevent blood clots from blocking the catheter and causing urine extravasation. Complex intracavitary perforations are rare. If they occur, the perforation should be sutured surgically. In addition, the abdominal cavity should be fully flushed to prevent tumor cell implantation.

After the bladder cancer patient's condition is confirmed, in addition to cooperating with the doctor to take treatment measures and do daily health care, bladder cancer patients are particularly required to maintain a good mental state. A good mentality plays a very important role in the treatment of bladder cancer. Only in this way can the treatment effect of bladder cancer patients be more ideal.