Difference between revisions of "Transurethral resection of bladder tumor"

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A transurethral resection of bladder tumor (TURBT) is an endoscopic procedure used to diagnose, stage, and treat early tumors of the bladder.  A resectoscope is passed into the bladder via the urethra and used to remove visible tumor.   
A '''transurethral resection of bladder tumor''' ('''TURBT''') is an endoscopic procedure used to diagnose, stage, and treat early tumors of the bladder.  A resectoscope is passed into the bladder via the urethra and used to remove visible tumor.   


== Preoperative management ==
== Preoperative management ==
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=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
* Can be performed under spinal anesthesia
** Spinal anesthesia will not eliminate


== Intraoperative management ==
== Intraoperative management ==


=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
* PIV x1


=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
* If GA, ETT vs. LMA
** Surgeon may request sustained muscle relaxation to limit movement from obturator nerve stimulation


=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
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=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===


* Stimulation of the obturator nerve during resectoscope passage into the urethra can cause a significant reflect, even while under GA.  To avoid this reflex, muscle relaxation is often used.  However, studies<ref>{{Cite journal|date=2007-08-01|title=Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor|url=https://www.sciencedirect.com/science/article/abs/pii/S1000194807600471|journal=Journal of Medical Colleges of PLA|language=en|volume=22|issue=4|pages=234–237|doi=10.1016/S1000-1948(07)60047-1|issn=1000-1948}}</ref> have shown that TIVA with LMA is a safe, reliable, and controllable method for maintenance of anesthesia with blunting of the obturator reflex. 
* Stimulation of the obturator nerve can cause significant movement, which creates risk of bladder perforation
**Risk increased if tumor involves lateral wall of the bladder 
**To avoid this reflex, muscle relaxation is often used  
*However, studies have shown that TIVA with LMA is a safe, reliable, and controllable method for maintenance of anesthesia with blunting of the obturator reflex<ref>{{Cite journal|date=2007-08-01|title=Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor|url=https://www.sciencedirect.com/science/article/abs/pii/S1000194807600471|journal=Journal of Medical Colleges of PLA|language=en|volume=22|issue=4|pages=234–237|doi=10.1016/S1000-1948(07)60047-1|issn=1000-1948}}</ref>  


=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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* Bleeding
* Bleeding
* Reabsorption  
* Reabsorption  
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
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== References ==
== References ==


[[Category:Surgical procedures]]
[[Category:Surgical procedures]]
<references />
[[Category:Urology]]

Latest revision as of 07:22, 9 April 2024

Transurethral resection of bladder tumor
Anesthesia type

GA or Neuraxial

Airway

ETT/LMA (if GA)

Lines and access

PIV x 1

Monitors

Standard

Primary anesthetic considerations
Preoperative
Intraoperative

Muscle relaxation may be requested by surgeon

Postoperative
Article quality
Editor rating
In development
User likes
0

A transurethral resection of bladder tumor (TURBT) is an endoscopic procedure used to diagnose, stage, and treat early tumors of the bladder. A resectoscope is passed into the bladder via the urethra and used to remove visible tumor.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

  • Can be performed under spinal anesthesia
    • Spinal anesthesia will not eliminate

Intraoperative management

Monitoring and access

  • PIV x1

Induction and airway management

  • If GA, ETT vs. LMA
    • Surgeon may request sustained muscle relaxation to limit movement from obturator nerve stimulation

Positioning

  • Lithotomy

Maintenance and surgical considerations

  • Stimulation of the obturator nerve can cause significant movement, which creates risk of bladder perforation
    • Risk increased if tumor involves lateral wall of the bladder
    • To avoid this reflex, muscle relaxation is often used
  • However, studies have shown that TIVA with LMA is a safe, reliable, and controllable method for maintenance of anesthesia with blunting of the obturator reflex[1]

Emergence

Postoperative management

Disposition

  • PACU

Pain management

Potential complications

  • Bladder perforation (most serious complication)
  • Urethral rupture or false passage
  • Bleeding
  • Reabsorption

References

  1. ↑ "Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor". Journal of Medical Colleges of PLA. 22 (4): 234–237. 2007-08-01. doi:10.1016/S1000-1948(07)60047-1. ISSN 1000-1948.

Top contributors: Barrett Larson, Chris Rishel and Tony Wang

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