Processing techniques and safety analysis for transurethral resection of bladder lesions

Abstract

Objective To evaluate the processing techniques and safety of ureteral stent after transurethral resection (TUR) of bladder lesions involving the ureteral orifice. Methods From January 2010 to August 2016, 42 cases of non-muscle invasive bladder tumor and 18 cases of glandular cystitis including 44 male and 16 female aged from 32 to 81 years(mean 55 years) were treated by TUR. Twenty-three cases of bladder tumor had single tumor and 19 cases had multiple tumors, and 37 cases were primary and 5 cases were recurrent. All the patients without preoperative hydronephrosis revealed by imageological examination.The lesions were resected into the deep muscle layer and involved ureteral orifice were resected during the procedure and after that a Double-J ureteral stent was placed in all cases.When looked for the ureteral orifice, we followed the ureteral peristalsis step by step, and found " concentric circles" muscle tissue.Then we used the guide wire as a guide for ureteral stenting. All the patients received one immediate intravesical instillation of 50 mg pirarubicin after TUR, and further scheme of adjuvant intravesical instillation was made according to the pathological diagnosis. Ureteral stents were removed 8~10 weeks after TUR, imageological examination were performed every three months. Results The operations were successful without complications. No serious adverse reaction occurred in adjuvant intravesical instillation chemotherapy. During the follow-up period of 4~60 months, no ureteral stricture and hydronephrosis occurred in all patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine. Conclusions The ureteral orifice usually need to be removed during TUR for bladder lesions, and the way we following the ureteral peristalsis to resect the ureteral orifice is effective.Ureteral stenting after TUR of bladder lesions involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract. Key words: Cystectomy; Urethra; Electrosurgery; Ureter