Anterior and Posterior Bladder Neck Dissection with Tension Stitch

Abstract

Abstract Introduction: In this video, we demonstrate both the anterior and the posterior bladder neck dissection with tension stitch. Placing a suture in the posterior bladder neck is a common approach in patients with median lobes, whereby the median lobe is retracted with a figure-of-eight suture. Materials and Methods: The 30-degree down lens is utilized for the most optimal view of this dissection. Results: Multiple visual cues are utilized to determine the location of the bladder neck, including the limits of the anterior prostatic fat pad, excursions of the Foley balloon, and tissue response to pinching maneuvers. The initial dissection focuses primarily in the midline, aiming to get down to vertical fibers, which appear just before the catheter is exposed. If the lateral contours of the prostate are readily apparent, this tissue may be taken down as well, bearing in mind that bleeding is often encountered laterally as shown. Once the catheter is exposed, some lateral progression will help define th...