Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section Iv: operations on the bladder and prostate
3-24
3-24. PARTIAL CYSTECTOMY
a. General. This procedure involves the resection of a portion of the bladder having a lesion.
b. Operative Procedure.
(1) The bladder and lesion are exposed via suprapubic abdominal, perineal, or vaginal approach. Usually the bladder is opened suprapubically, as described in paragraph 3-22e.
(2) The ureteral orifices are identified and ureteral catheters passed.
(3) The diseased portion of the bladder is excised, using clamps and ligatures of the type required for the organs and tissues involved. Vessels are tied with number 2-0 plain gut.
(a) For vesicointestinal fistula, bowel resection with colostomy or ileostomy may be indicated. For vesicovaginal fistula, a vaginal plastic repair is done.
(b) For diverticulum, excision of the defect is done intravesically or extravesically.
(4) The incision in the bladder is sutured in two layers, as described in paragraph 3-22e(4).
(5) The bladder is drained suprapubically, as well as by an indwelling urethral catheter. Penrose drains may also be placed in the wounds.
