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Randa Halfian
Definition
Incision of the bladder for removal of a
calculus.
Electronic cauter
Surgical blade no 23, 11, scalpel
handle
Langenbac
k Kocher
Sharp spreader Suction
Allis clamp
Preparation
Pean/mosquito
Pinset Scissors Metzenbaum Needle holder
clamp
Stone forceps
Spreader
Preparation
Vicryl 1-0
(Hinmans Atlas of
Urologic Surgery,3rd
ed)
Washout the bladder cavity with normal
saline
Evaluate the bladder wall
(for tumor or diverticle), the ureter ends (for
stones and ureteric jet), and size of bladder
neck. Inspect the base of the bladder for other
stones.
Take specimen for bladder biopsy if the
size of the stone is more than 3 cm.
Evaluate the prostate through the bladder
Procedures
Insert a 16 F urethral catheter then
washout the bladder cavity through
the catheter.
Close the bladder with a running 3-0
plain catgut suture applied to the
muscularis mucosal layer.
Reinforce it with interrupted sutures of
3-0 polyglactin placed through the
seromuscularis.
Fill the bladder with 250 cc of
normal saline through urethral
catheter, evaluate if there is any
leaks within the sutures.
Procedures
Place a small suction drain
(paravesical) to exit
through the wound for a
few days.
Stitch layer by layer
fascia of rectus
abdominis muscle with
polyglactin 1-0
subcutaneous tissue with
plain catgut 3-0
the skin with stepler
Close the wound with tulle
and sterile gauze.
Intraoperativ
Early Postop Late Postop
e
Bleeding Bleeding Peritonitis
Damage to Other
other infections
intraabdomin Fistules
al organs
(Campbell,10th
ed)
Post Surgical Care
Remove the catheter after day 7.
Remove the drain if the production is
minimal (<20 cc/24 hour) after catheter
removal.
Analyze the composing material of the
stone.