Bladder growth in right lateral wall diverticulum -issues encountered

• 21 Apr 2020 10:37:04 AM
• |Onco Urology

Posting image of case of 60 year male patient I discussed in another thread. 

Comments(5)

• 

  Ravindra Sabnis

  22 Apr 2020 04:58:32 PM

  Bladder diverticular growth is very tricky. By defination, diverticulum does not have muscle. So if it is high grade, it should be treated like muscle invasive disease. 

• 

  Dr. Anil Takvani

  22 Apr 2020 05:49:46 PM

  Sir,

  Thanks.

  I hope many trainees in group will try answering this post.

  Thanks

• 

  Pankaj N Maheshwari

  01 May 2020 01:57:50 PM

  This patient has a large tumor in bladder diverticulum. I would not attempt resection as resection of such large tumors can lead to bladder perforation. I would take biopsy from tumor and random biopsies from the bladder and then consider either a diverticulectomy, partial cystectomy or radical cystectomy. 

  Resection would be reserved for very small tumors.

  Link to an interesting article on tumors in bladder diverticulum: https://www.eu-focus.europeanurology.com/article/S2405-4569(18)30382-1/pdf

  
  

• 

  Pankaj N Maheshwari

  01 May 2020 04:53:35 PM

  Measures to reduce obturator spasms during TUR-BT

  1. Avoid over distension of the bladder
  2. Reduce Diathermy current
  3. The chance may be less with bipolar as compared to mono-polar. There is literature on either side. 
  4. Obturator nerve block
  5. Use laser energy for en-bloc excision of tumors :) :)
  6. GA with muscle relaxants

  One common mis-concept is that spinal anaesthesia prevents obturator spasms. It cannot as the cause of spasms is a local stimulation of the nerve. 

  One very interesting article for post-graduates: Avoiding the obturator jerk during TURBT. 

  https://www.karger.com/Article/Pdf/447223

• 

  Dr. Anil Takvani

  01 May 2020 06:27:09 PM

  Thank you very much Pankaj Sir