PREOPERATIVE DIAGNOSIS: Recurrent transitional cell carcinoma with carcinoma in situ urinary bladder.
POSTOPERATIVE DIAGNOSIS: Recurrent transitional cell carcinoma with carcinoma in situ urinary bladder.
PROCEDURE PERFORMED: Cystoscopy with multiple bladder biopsies and bladder fulguration.
SUMMARY: Under excellent general anesthesia the patients genitalia were sterilely prepped and draped with the patient in lithotomy position. A 24-French cystourethroscope was introduced into the bladder and the bladder was reviewed with both Foroblique and right angle lenses. Previously noted areas suspicious for carcinoma in situ were noted on the posterior wall in the midline and on the right lateral bladder wall and there were some areas of frank papillary formation located anteriorly just inside the bladder neck and at about the 11 o'clock position of the right lateral wall just inside the bladder neck. Cup biopsy forceps were used to obtain bladder mucosal pieces from 3 different sites of area suspicious for carcinoma in situ. The cystoscope was then exchanged for a continuous flow resectoscope with roller ball electrode and the areas of papillary formation were completely fulgurated as were the biopsy sites and surrounding suspicious mucosa. All fulguration was well away from the patients ureteral orifices.
The bladder biopsy pieces were submitted to pathology and the bladder was then emptied, and a 16 French Foley catheter was passed into the bladder and the balloon inflated.
The patient tolerated the procedure well. There was no blood loss and he was sent to recovery in satisfactory and stable condition.