Transurethral resection of bladder tumour (TURBT)

Patient and case

1. Name / Age / Sex
2. UHID / IP no. / Ward-Bed
3. Date of surgery / OT no.
4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

1. Operating surgeonname, designation
2. Assistant(s)
3. Supervising consultantpresent in OT / available / not applicable
4. Steps done by the residentwhole procedure / named steps, under whose supervision
5. Anaesthetist
6. Scrub nurse / circulating nurse

Diagnosis and procedure

1. Pre-operative diagnosis
2. Post-operative diagnosis
3. Procedure planned
4. Procedure performedif different from plan, state why
5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
2. Site / side markedYesNot applicable
3. WHO Surgical Safety ChecklistSign inTime outSign out
4. Antibiotic prophylaxisdrug, dose, route, time given before incision
5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

• bleeding and clot retention
• bladder perforation, which may need catheter drainage or open or laparoscopic repair
• obturator nerve jerk during lateral wall resection
• ureteric orifice injury or obstruction, sometimes needing a stent
• urinary infection
• urinary retention and irritative symptoms
• incomplete resection and need for a second-look resection
• recurrence of tumour and need for repeat cystoscopies

Pre-operative details for this operation

1. Presentationhaematuria (painless / clots), incidental finding, recurrence on check cystoscopy
2. ImagingUSG / CT urography: size, site, number, hydronephrosis, upper tract lesions
3. Primary or recurrentif recurrent: previous stage, grade, intravesical therapy
4. Urine culture and cytologyresult and date
5. Anticoagulants / antiplateletsdrug and date stopped
6. Smoking history

Anaesthesia and position

1. AnaesthesiaGeneral with muscle relaxantSpinalwrite why, if lateral wall tumour
2. PositionModified dorsal lithotomy
3. Bimanual examination under anaesthesiaNo palpable massMobile massFixed massbefore and after resection
4. Energy and irrigantMonopolar with sterile waterMonopolar with 1.5% glycineBipolar with 0.9% salineLasergenerator settings; total irrigant volume
5. Resectoscope and lensessheath size (Fr); 30 and 70 degree lenses

Operative findings

1. Urethra and prostatic urethranormal / tumour / stricture
2. Number of tumours
3. Site of each tumourwall (right / left lateral, posterior, trigone, dome, anterior, bladder neck), relation to ureteric orifices; draw a bladder diagram
4. Size of largest tumourin cm (compare with loop width)
5. AppearancePapillarySessileNodularFlat red patch (suspect CIS)
6. Ureteric orificesboth seen, efflux clear / involved
7. Rest of bladdertrabeculation, diverticulum (tumour inside?), stones
8. Enhanced cystoscopyNot usedNarrow-band imagingBlue lightextra lesions found

Procedure (steps)

1. Cystourethroscopyfull survey with 30 and 70 degree lenses
2. TechniqueLoop resection (piecemeal)En bloc resectionCold cup biopsyFulguration only
3. Exophytic part resectedfrom periphery in layers for large sessile tumours; in one swipe for small papillary ones
4. Tumour base resecteddepth: into muscularis propria but not through it
5. Base sample sent separatelyYesNo
6. Resection near ureteric orificeNot neededDone with pure cut current
7. Other biopsiesrandom / suspicious areas / prostatic urethra; site of each
8. Chip evacuationEllik evacuator
9. Haemostasisedges and base coagulated; checked with flow off and bladder emptied
10. Resection visually completeYesNo (what was left and why)
11. PerforationNoneExtraperitonealIntraperitonealSuspected, cystogram donefat seen? action taken
12. Resection timeminutes

Closure, drains and dressing

1. Cathetersize (Fr), two-way / three-way, balloon volume in ml
2. Continuous bladder irrigationNot neededStarted (fluid, rate)
3. Single post-operative intravesical chemotherapyGiven (drug, dose, time, dwell time)Not given (reason: perforation / heavy bleeding / other)
4. Ureteric stentNonePlaced (side, size, length, removal date)

Specimens and implants

1. Tumour chipsone container per site, labelled with site; weight in grams
2. Tumour base / deep muscleseparate labelled container
3. Other biopsieseach in its own labelled container
4. Requisitionclinical details, site of each specimen, primary or recurrent

End of procedure

1. Estimated blood lossml
2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
3. Swab, needle and instrument countCorrectIncorrect: action taken
4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

1. Vitalshourly for 4 hours
2. Urine colour and catheter drainagewatch for clots; hand wash with catheter-tip syringe if blocked
3. Continuous bladder irrigationif started: fluid, rate, stop when clear
4. Abdominal distension or painmay mean perforation: inform at once
5. Intravesical chemotherapyif ordered: drug, dose, dwell time, then drain; handle as cytotoxic
6. Catheter removal and voiding trialday planned
7. Serum sodiumif glycine or water used for a long resection
8. HPE follow-update to review report; need for second-look resection decided on the report

Signature

1. Name and designation of person writing note
2. Medical Council registration no.
3. Signature / date / time of writingwrite before the patient leaves recovery