Instruments Used in TURBT (Transurethral Resection of Bladder Tumor) Surgery

During TURBT (Transurethral Resection of Bladder Tumor), a specialized set of urological instruments is used to access and remove bladder tumors via the urethra—without external incisions.

Instrument Names Used in TURBT Surgery:
Resectoscope
Working Element (active part of resectoscope)
Cutting Loop Electrode (monopolar or bipolar)
Light Cable and Camera Head
Irrigation Tubing Set
Saline or Glycine Irrigation Fluid
Ellik Evacuator or Toomey Syringe
Cautery Electrode / Coagulation Electrode
Bladder Distension Sheath
Biopsy Forceps (if tissue sampling is needed)
Electrosurgical Generator Unit (ESU)
e.g., Bipolar Saline Electrosurgical Unit – 400W
Suction Tubing and Collection Canister
Operating Table with Leg Supports (Lithotomy Position)

These instruments work together to perform the resection and removal of bladder tumors through the urethra, without open surgery.

TURBT (Transurethral Resection of Bladder Tumor) is typically needed when a person is suspected to have or has been diagnosed with a bladder tumor, especially at early stages. It plays a crucial role in both diagnosis and initial treatment.

We need TURBT (Transurethral Resection of Bladder Tumor) in the following situations:
1. Diagnosis of Bladder Cancer
When a person has symptoms like:
Blood in urine (hematuria)
Frequent or painful urination
Imaging or cystoscopy shows a suspicious mass or lesion in the bladder.
TURBT helps confirm if the tumor is cancerous, and determines the type, grade, and depth of invasion.

2. Initial Treatment of Early-Stage Bladder Cancer
Especially for non-muscle invasive bladder cancer (NMIBC):
Ta (confined to bladder lining)
T1 (into connective tissue)
CIS (flat carcinoma in situ)
TURBT removes the tumor completely, often followed by intravesical therapy (e.g. BCG).

3. Restaging or Repeat TURBT
If the initial tumor is:
High-grade
T1 stage
A second TURBT (within 2–6 weeks) is often done to ensure complete removal and accurate staging.

4. Relief of Urinary Symptoms in Advanced Cancer
When the tumor causes:
Bleeding
Blockage of urine flow
TURBT may be done for palliative purposes, not cure.

Procedure of TURBT (Transurethral Resection of Bladder Tumor)
1. Preoperative Preparation
Admission: Usually done as a day-care or short hospital stay.
Anesthesia: Spinal or general anesthesia is administered.
Positioning: Patient lies on their back with legs supported in stirrups (lithotomy position).

2. Insertion of the Resectoscope
A resectoscope (a thin tube with a camera and surgical loop) is gently inserted through the urethra into the bladder.
No external incision is made.

3. Visual Inspection of the Bladder
The surgeon examines the inside of the bladder for:
Tumor(s) — their size, location, and number
Bladder wall condition
Any suspicious areas for biopsy

4. Tumor Resection
The tumor is shaved off in layers using the resectoscope’s electric loop.
If necessary, tissue from the base of the tumor (including muscle layer) is also taken to check how deep the tumor has grown.

5. Control of Bleeding (Hemostasis)
The surgical area is cauterized to stop bleeding.
Irrigation fluid is used to flush out blood clots and tissue pieces from the bladder.

6. Tissue Collection for Biopsy
Tumor and bladder wall tissue samples are collected and sent for pathological analysis to determine:
Cancer presence
Type, grade, and stage

7. Catheter Placement
A Foley catheter is inserted into the bladder to:
Drain urine
Prevent blockage from clots
Allow bladder to heal
Bladder irrigation may be used to prevent clot formation.

Postoperative Care
Hospital Stay: Usually 1–2 days depending on recovery.
Catheter Removal: Within 24–72 hours typically.
Pathology Report: Usually ready within 7–10 days to guide further treatment.

Duration of Procedure
Typically takes 30–90 minutes depending on the number and size of tumors.

During Bladder Augmentation Surgery, various surgical instruments are used to perform the procedure efficiently and safely. Here’s a list of common instruments:

step-by-step list of instruments

1. Preparation Phase:
Surgical Scalpels: For making the initial incision in the abdominal area.
Needle Holder: To securely hold needles for suturing.

2. Accessing the Bladder:
Surgical Scissors: To dissect and open up layers of tissue to reach the bladder.
Bladder Retractors: Used to hold the bladder open for better access.

3. Harvesting Intestinal Tissue:
Intestinal Forceps: To clamp and hold the intestinal segment to be used for augmentation.
Bowel Clamp: To temporarily stop the blood flow to the portion of the intestine being removed.
Scissors or Electrocautery: To cut the section of the intestine.

4. Preparing and Attaching Intestinal Tissue to the Bladder:
Needle Holder and Suturing Instruments: For stitching the harvested segment of intestine to the bladder.
Surgical Scissors: For trimming any excess tissue.
Electrocautery (Diathermy): For coagulating small blood vessels to minimize bleeding.

5. Closing the Incision:
Sutures (Absorbable or Non-absorbable): To close the abdominal and bladder incisions.
Staplers: Occasionally used for closing the larger incisions in the bladder or abdominal wall.

6. Post-Operative Care:
Catheters: A catheter is inserted into the bladder for draining urine during recovery.
Drainage Tubes: May be used to prevent fluid buildup after surgery.

7. Final Inspection and Closure:
Sterile Drapes and Covers: To ensure a sterile environment during surgery.
Sutures or Staplers: To close the abdominal incision.

These instruments work together to ensure that the bladder augmentation procedure is successful and safe.

Bladder Augmentation is needed when the bladder is too small, stiff, or unable to store urine properly, causing serious problems.

Bladder Augmentation is needed when:
Bladder cannot hold enough urine (small bladder capacity).
Bladder is too stiff or high-pressure, risking kidney damage.
Severe urinary incontinence that doesn’t improve with medication or catheter use.
Neurogenic bladder (due to spinal cord injury, spina bifida, etc.).
Congenital bladder problems like bladder exstrophy or other birth defects.
Chronic bladder inflammation or damage from radiation, infection, or long-term catheter use.
Urine backing up to kidneys (vesicoureteral reflux) due to poor bladder function.

Procedure of Bladder Augmentation (Augmentation Cystoplasty)

1. Anesthesia
The patient is placed under general anesthesia (completely unconscious).

2. Opening the Abdomen
A surgical incision is made in the lower abdomen to access the bladder.

3. Opening the Bladder
The surgeon cuts open the bladder at the top to prepare it for expansion.

4. Removing a Section of Intestine
A small piece of intestine (usually ileum) is removed.
The intestine is then reconnected so digestion continues normally.

5. Attaching Intestine to Bladder
The intestinal segment is reshaped and sewn to the bladder to increase its size and reduce pressure.

6. Closing the Incision
A catheter is placed into the bladder to drain urine.
The abdominal incision is closed with stitches.

7. Post-Surgery Recovery
Hospital stay: 7–10 days.
Catheter use: 2–3 weeks.
Patient may need to learn self-catheterization for bladder emptying.

Benefits
Increased bladder capacity – can hold more urine comfortably.
Reduced bladder pressure – protects the kidneys from damage.
Improved continence – helps control urine leakage.
Better quality of life – less urgency, fewer infections, and more independence.

Here is a list of specific instruments used in cystectomy surgery (bladder removal surgery):

Basic Surgical Instruments:
Scalpel – For making precise incisions in the skin and tissues.
Mayo scissors – For cutting soft tissues during dissection.
Metzenbaum scissors – For finer dissection of delicate tissues.
Needle holder – Used to hold needles while suturing.
Kelly clamp – For clamping blood vessels and tissues to control bleeding.
Mosquito clamp – A smaller version of the Kelly clamp, used for smaller blood vessels.

Instruments for Bladder and Pelvic Surgery:
Balfour retractor – A self-retaining retractor to hold the abdominal cavity open for better access.
DeBakey forceps – For grasping tissues delicately, used to hold and manipulate tissues.
Allis forceps – Used to grasp tissues, especially in deeper regions.
Surgical suction – Used to remove blood and fluids, maintaining a clear surgical field.
Electrocautery (Bovie) – An electrical tool used to cut tissue and coagulate blood vessels to minimize bleeding.
Bladder dissector – To carefully separate the bladder from surrounding tissues.

Laparoscopic or Robotic-Assisted Instruments (if minimally invasive):
Trocars – Tubes inserted into the abdomen to create access points for laparoscopic instruments.
Laparoscope – A small camera inserted through a trocar to view the internal surgical site.
Graspers – Instruments used for holding and manipulating tissues during laparoscopic surgery.
Laparoscopic scissors – Special scissors for cutting tissues during minimally invasive surgery.
Endoscopic stapler – Used for stapling tissues together, often in laparoscopic procedures.

Urinary Diversion Instruments:
Bowel clamps – Used to isolate portions of the bowel for creating urinary diversions, such as an ileal conduit.
Catheters – Used for draining urine during the procedure and post-surgery.
Stents – Tubes used to keep the urinary system open after surgery.
Staplers – Used in creating an ileal conduit or a neobladder.
Stoma measuring device – To measure and create a proper site for the urinary diversion.

Closure Instruments:
Sutures – To close incisions after the procedure.
Staples – Used to close larger incisions or areas that require quicker closure.

These instruments are used to carry out different stages of the cystectomy procedure, including bladder removal, tissue dissection, and urinary diversion creation.

A cystectomy is a surgical procedure to remove all or part of the urinary bladder. It is most commonly performed to treat bladder cancer, but it may also be done for other conditions like chronic bladder inflammation, severe trauma, or congenital defects.

Types of Cystectomy:
Partial Cystectomy – Only a part of the bladder is removed (usually if cancer is small and localized).
Radical Cystectomy – The entire bladder is removed.
Bladder Cancer (most common reason)
Especially if it is muscle-invasive or high-grade and does not respond to treatments like chemotherapy or BCG.
Severe Bladder Damage
From trauma, radiation therapy, or chronic inflammation.
Painful Bladder Conditions
Such as interstitial cystitis that does not respond to other treatments.
Birth Defects
Rarely, if the bladder is malformed and non-functional.
Neurological Bladder Dysfunction
In very severe cases where the bladder cannot empty or store urine properly, and other treatments fail.

Step-by-Step Cystectomy Procedure
1. Pre-operative Preparation
Medical tests: Blood work, urine tests, imaging (CT/MRI), EKG.
Bowel prep: Cleansing of the intestines if a urinary diversion will involve the bowel.
Fasting: No food or drink for several hours before surgery.
Consent: Patient is informed and signs surgical consent.

2. Anesthesia
General anesthesia is administered — the patient is fully unconscious and pain-free.

3. Positioning and Sterile Prep
The patient is positioned on the operating table.
The abdomen is cleaned and sterilized to prevent infection.

4. Surgical Incision
Open surgery: A vertical incision is made in the lower abdomen.
Minimally invasive (laparoscopic/robotic): Several small incisions are made for camera and tools.

5. Removal of the Bladder and Nearby Organs
The bladder is carefully detached from surrounding tissues.
In men: Bladder + prostate + seminal vesicles are removed

In women: Bladder + uterus + part of vagina + ovaries (sometimes) are removed.

6. Lymph Node Dissection
Pelvic lymph nodes are removed and sent for testing to check for cancer spread.

7. Urinary Diversion Construction

Since the bladder is gone, a new pathway for urine is created:
Ileal conduit: A piece of small intestine is used to connect ureters to a stoma (urine collects in a bag).
Neobladder: A new bladder made from intestine, connected to the urethra (you can urinate normally).
Continent reservoir: A pouch is created inside the body and emptied using a catheter.

8. Closure
All internal structures are checked for leaks.
Drains and catheters are placed.
The incision is closed with sutures or staples.

9. Recovery in Hospital
ICU or recovery room monitoring.
Pain control, IV fluids, and gradual reintroduction of diet.
Patient learns to manage urine diversion (if needed).
Hospital stay: usually 5–10 days.

The main instrument used in SWL is the lithotripter — a specialized medical device designed to generate and focus shock waves to break kidney or ureteral stones.

Step-by-Step Instruments Used in Shock Wave Lithotripsy (SWL)

1. Pre-Procedure Stage
Patient Evaluation – Ultrasound Machine | X-ray/CT Scanner – To locate the stone and assess size/location
Vital Monitoring – BP Monitor | ECG Monitor – To monitor heart rate, oxygen, blood pressure
Sedation (if required) – IV line, syringes, anesthetic setup – For patient comfort and pain control

2. Positioning and Preparation
Positioning Patient – Adjustable SWL Table – To properly align the patient with the machine
Shock Transmission Medium – Water cushion, gel pad, or water bath – Helps conduct shock waves to the body

3. Lithotripsy Procedure
Stone Localization – Fluoroscopy or Ultrasound Guidance – Real-time targeting of the stone
Shock Wave Delivery – Lithotripter Machine – Generates and focuses shock waves on stone

Types of Lithotripters:
Electrohydraulic Lithotripter
Electromagnetic Lithotripter
Piezoelectric Lithotripter

4. Post-Procedure Monitoring
Vital Sign Monitoring – ECG, Pulse Oximeter, BP Monitor – To check patient stability after treatment
Urine Output Observation – Urine collection system, Urinometer – To detect stone fragments and urine flow
Follow-Up Imaging – Ultrasound or X-ray – To confirm stone clearance

Shock Wave Lithotripsy (SWL) is a non-invasive medical procedure used to break kidney or ureteral stones into smaller pieces using high-energy sound waves (shock waves). These small fragments can then pass naturally through the urinary tract

You may need SWL if

You have kidney stones or ureter stones between 4 mm to 20 mm.
The stone is visible on X-ray or ultrasound.
The stone is in the kidney or upper ureter.
You have pain, bleeding, or infection due to stones.
You want to avoid surgery.
Other treatments (like medications) did not work.

Here is a step-by-step explanation of how Shock Wave Lithotripsy (SWL) is performed

1. Pre-Procedure Preparation
Medical Evaluation – Imaging tests (X-ray, CT scan, or ultrasound) are done to locate the stone and determine its size and position.
Fasting – You may be asked to avoid food and drink for 6–8 hours before the procedure.
Medication Review – Blood thinners or certain medications may be stopped temporarily.
Anesthesia – Light sedation or general anesthesia may be used to reduce pain or movement during the procedure.

2. During the Procedure

Positioning – You lie on a water-filled cushion or a special table, depending on the machine used.
Imaging Guidance – The doctor uses X-ray or ultrasound to target the stone accurately.
Shock Wave Delivery – A lithotripter machine generates high-energy sound waves focused on the stone.
Stone Fragmentation – The shock waves pass through the skin and break the stone into small fragments.
Duration – The procedure typically lasts 30 to 60 minutes.

3. Post-Procedure Care
Observation – You may be monitored for a few hours and discharged the same day.
Symptoms – Mild pain, blood in urine, or bruising at the skin site is common.
Hydration – You are advised to drink plenty of fluids to flush out stone fragments.
Medications – Pain relievers and sometimes antibiotics are prescribed.
Follow-up – Imaging is done after a few weeks to ensure the stone is cleared completely.

You may pass stone fragments over several days to weeks.
Some patients may need repeat SWL sessions if stones are not completely broken.
If SWL fails, other options like URS (ureteroscopy) or PCNL may be considered.

Ureteroscopy (URS) is a minimally invasive urological procedure used to diagnose and treat conditions of the ureter and kidney, such as stones, tumors, or strictures. It involves the insertion of a ureteroscope (a thin, flexible or rigid scope) through the urethra and bladder into the ureter.

Here is a list of instrument names used in Ureteroscopy (URS):

1. Ureteroscope
Types:
Rigid ureteroscope – for lower ureter.
Flexible ureteroscope – for upper ureter and kidney.
Semi-rigid ureteroscope – for mid-ureter and some upper ureter access.
Allows visualization and access to the ureter and renal pelvis.

2. Guidewires
Hydrophilic Guidewire – for easy ureteral navigation.
Zebra Wire / Amplatz Wire – for support and safety.
PTFE Guide Wire – To safely access and guide instruments into the ureter.
Fluoroscopy – confirms stent position.

3. Access Sheaths
Ureteral Access Sheath (UAS) – facilitates repeated passage of instruments, reduces intrarenal pressure, and protects the ureter.
URS Forceps – To grasp and retrieve stones or tissue samples.
Bugbee Electrode – For cauterization and tumor ablation during URS.

4. Irrigation System
Maintains clear vision by flushing the field.
Manual syringe or pressurized bag system.

5. Stone Retrieval Devices
Stone retrieval baskets (Nitinol / Stainless) – To capture and remove stone fragments from the ureter/kidney.
Grasping Forceps – to retrieve stones or tissue.

6. Lithotripsy Devices (for stone fragmentation)
Holmium:YAG Laser – most commonly used.
Ultrasonic lithotripter
Pneumatic lithotripter

7. Dilators and Catheters
Ureteral Dilators or metal dilators – to widen the ureteral orifice.
Balloon Dilators – for precise dilation.

8. Stents and Tubes
Double-J (DJ) Stents – placed post-procedure to prevent obstruction and promote healing.
Ureteral Catheters – for dye injection or drainage.

9. Contrast Media and Monitoring Tools
Ureteroscope withdrawal – under vision to avoid trauma.
C-arm Fluoroscopy Unit – real-time X-ray guidance.
LED Light Source – Provides bright illumination for endoscopic visualization.
Fiber Optic Cable – Transmits light from the LED source to the ureteroscope.

Ureteroscopy (URS) is needed when there are issues in the ureters or kidneys, such as:

Kidney or Ureteral Stones: Large stones causing pain or blockage.
Obstructions: Blockages in the ureter due to stones, scarring, or strictures
Tumors: Suspicion of tumors in the urinary tract.
Hematuria: Unexplained blood in the urine.
Strictures: Narrowing of the ureter affecting urine flow.
Chronic or Recurrent Infections: Due to underlying stones or blockages.
Post-Surgical Follow-Up: After stone removal or other treatments.

It’s used to remove stones, clear obstructions, or diagnose and treat urinary tract problems.

Here’s a short step-by-step procedure for Ureteroscopy (URS):

1. Preparation:
Anesthesia: Local or general anesthesia is given.
Fasting: You may be instructed to avoid eating or drinking before the procedure.
IV Line: For fluids or medications.

2. Positioning:
You lie on your back with legs slightly spread.
The area is sterilized.

3. Insertion of Cystoscope:
A thin tube (cystoscope) is inserted through the urethra into the bladder.

4. Insertion of Ureteroscope:
A ureteroscope is inserted through the cystoscope into the ureter and possibly the kidneys for examination.

5. Examination & Diagnosis:
The doctor checks for stones, blockages, tumors, or strictures in the urinary tract.

6. Treatment (if necessary):
Stones are removed or broken up with a laser.
Tumors may be biopsied or removed.
A stent may be placed if needed to keep the ureter open.

7. Completion:
The ureteroscope and instruments are removed.
If a stent was placed, it may remain for a few days to a few weeks.

8. Recovery:
The procedure typically lasts 30-60 minutes.
You can usually go home the same day and resume normal activities in a few days.

Benefits of Ureteroscopy (URS)
Minimally invasive (no cuts)
Effectively removes kidney/ureteral stones
Quick recovery time
Usually done as a day procedure
Accurate diagnosis and treatment
Safe with low complication risk