toria11
Guru
Hi! I'm going back and forth between these two codes. The op note states large amount of clot were evacuated with a resectoscope but the provider also fulgurated the floor of the bladder and trigone. Thoughts?
"She was then placed in the dorsal lithotomy position, prepped and draped in a sterile fashion and a rigid resectoscope was placed into her bladder and a combination of transurethral resection with a hot loop of fibrinous clot and utilization of Ellik evacuators and Toomey syringes, I was eventually able to rid the bladder of this massive clot material. I would estimate that it was a volume of about 500 mL or at least a unit and a half of blood. I then used the rollerball to fulgurate the floor of the bladder. I did not appreciate any fungating masses. I did not appreciate any stones, but the visualization was very murky secondary to the amount of hematuria present. There were several telangiectatic vessels in the trigoneal area of the bladder as might be expected from the radiation therapy, so I cauterized these extensively, but I did not see any gross bleeding.
At the termination of the case, the urine was fairly clear. Because she has a latex allergy, we utilized a 22-French 3-way silicone catheter, inflated the balloon to 30 mL, and placed her on a sterile saline continuous bladder irrigation. "
Thanks for your help!
"She was then placed in the dorsal lithotomy position, prepped and draped in a sterile fashion and a rigid resectoscope was placed into her bladder and a combination of transurethral resection with a hot loop of fibrinous clot and utilization of Ellik evacuators and Toomey syringes, I was eventually able to rid the bladder of this massive clot material. I would estimate that it was a volume of about 500 mL or at least a unit and a half of blood. I then used the rollerball to fulgurate the floor of the bladder. I did not appreciate any fungating masses. I did not appreciate any stones, but the visualization was very murky secondary to the amount of hematuria present. There were several telangiectatic vessels in the trigoneal area of the bladder as might be expected from the radiation therapy, so I cauterized these extensively, but I did not see any gross bleeding.
At the termination of the case, the urine was fairly clear. Because she has a latex allergy, we utilized a 22-French 3-way silicone catheter, inflated the balloon to 30 mL, and placed her on a sterile saline continuous bladder irrigation. "
Thanks for your help!