Transvesical Crosstrigonal Approach

Under general anesthesia, cystoscopy is performed with the patient in the modified lithotomy position. A double-pigtail ureteral catheter is placed in the ureter. Two 5-mm balloon tip ports are inserted suprapubically into the distended bladder under cystoscopic visualization. These are passed one fingerbreadth superior to the pubic symphysis on either side of the midline. The balloons are inflated and the cuffs cinched down and secured to prevent extravasation of irrigation during the procedure. Both ports are placed to light wall suction to maintain a partially distended bladder throughout the procedure. Suction is adjusted to allow adequate distension for exposure, but to prevent overdistension and resulting extravasation. The cystoscope is exchanged for a resectoscope with Collins knife. Visualization for the entire procedure is maintained through the resectoscope.

Patients are kept in the hospital for 24 to 48 hours postoperatively and require minimal analgesia. Patients have been sent home with a Foley catheter for one week, though a shorter duration may be adequate. No drain is necessary, and the double-J stent may be removed at the end of the procedure or left in place at the surgeon's discretion.

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