Bladder leiomyoma

RE: Bladder leiomyoma

Martin Atkinson — Thu, 29 Oct 2015 09:10:24 GMT

[quote user="grumpyoldman"]Reminds me of a client in a consult when I said.....[/quote]And that reminds me of a typical mental, boisterous, 6 month old Doberman I was routinely castrating back in the day which went into cardiac arrest. External cardiac massage and intra-cardiac adrenaline did nothing so I quickly sliced open it's chest and performed internal cardiac massage, It worked and the dog made a full recovery. I have no doubt the owner thought I was to blame for the problem in the first place rather than being a hero for saving her dog. However I don't think it helped when I made a glib remark that if the dog had permanent brain damage no-one could tell as all Dobies are born with it! I'd like to say that I was a bit foot loose and fancy free back then but as you are aware from my contributions to this forum I'm still not immune to putting my foot in it from time to time. Sadly not everyone has a morbid sense of humour.

RE: Bladder leiomyoma

grumpyoldman — Wed, 28 Oct 2015 20:52:56 GMT

[quote user="Evelyn Barbour-Hill"] Good job she didn't "report" you.... [/quote]

Yes need to be careful these days ,treading on the cracks in the pavement with the PC police in full flow. Reminds me of a client in a consult when I said ,while syringing her dogs ear , " let me know if it comes out the other side that may mean we have a more serious issue" , she really did watch the dogs other ear for the rest of the process , while her husband stood behind with an enormous grin on his face. She rang later to complain to the manager, and i promised to have a word with myself.

RE: Bladder leiomyoma

Evelyn Barbour-Hill — Wed, 28 Oct 2015 17:59:29 GMT

[quote user="grumpyoldman"]so placed a bioSis sheet behind it on each side . Seemed to work well ,we had it from Centaur .[/quote]

How long ago?

[quote user="grumpyoldman"]Sterilised a dried apple slice which looks very similar in the shape of a ring with a hole in it. Managed to persuade them it was in fact a prosthetic arse hole. [/quote]

Good job she didn't "report" you....

RE: Bladder leiomyoma

grumpyoldman — Wed, 28 Oct 2015 12:47:42 GMT

[quote user="Evelyn Barbour-Hill"]Was that a typo for BioSis? [/quote]

Yes , I last used it on a 14 yr old yorkie with a perineal hernia ,the internal obturator graft looked very flimsy and insubstantial as did the other muscles ,was not sure if it would hold ,so placed a bioSis sheet behind it on each side . Seemed to work well ,we had it from Centaur . I only remembered that because I played a practical joke on the head nurse who was just back from maternity leave and feeling a bit rusty. Sterilised a dried apple slice which looks very similar in the shape of a ring with a hole in it. Managed to persuade them it was in fact a prosthetic arse hole.

RE: Bladder leiomyoma

Martin Atkinson — Wed, 28 Oct 2015 08:49:51 GMT

[quote user="grumpyoldman"]make a small linear incision for a small cystotomy ,then inflate with a condom attached to a 3-way tap and hartmanns ,so your operating on a partially distended bladder rather than the empty .[/quote]A cunning plan but although it has occasionally been a bit of a challenge, especially if the bladder goes into a spasm, I've always managed. I used to worry about a bladder that looked a bit like a piece of ravioli after I'd done and tried various purse string suturing techniques but I don't bother now, it over-complicates things and even odd shaped bladders seem to adapt very well.

Interested how you make the condom leak-proof though.

[quote user="grumpyoldman"]there are techniques for using loops of bowel and splitting/sharing mucosa and replacing with biosys. [/quote]I've never had one that needed that, at least where the owver was prepared to proceed, but I think nowadays I would accept my surgical limitations and refer that sort of case.

RE: Bladder leiomyoma

Evelyn Barbour-Hill — Tue, 27 Oct 2015 23:40:10 GMT

[quote user="grumpyoldman"] biosys.[/quote]

Was that a typo for BioSis? If so, can you still get it (other than in piddling little corneal discs)? Where?

[quote user="grumpyoldman"]The other thing i have done is make a small linear incision for a small cystotomy ,then inflate with a condom attached to a 3-way tap and hartmanns [/quote]

That's a brilliant idea.

RE: Bladder leiomyoma

grumpyoldman — Tue, 27 Oct 2015 23:34:44 GMT

The other thing i have done is make a small linear incision for a small cystotomy ,then inflate with a condom attached to a 3-way tap and hartmanns ,so your operating on a partially distended bladder rather than the empty . , gives a better idea how much to remove and how well its going to fit back together afterwards. there are techniques for using loops of bowel and splitting/sharing mucosa and replacing with biosys.

RE: Bladder leiomyoma

Martin Atkinson — Tue, 27 Oct 2015 18:30:36 GMT

I have surgically resected a number of bladder wall tumours and provided they don't actually involve the urethral exit they've all turned out OK. If you're a confident surgeon it is surprisingly easy. Sometimes there has been barely enough bladder to close the surgical site and they go home with dire warnings that they may need to pee every five minutes but it never ceases to amaze me how well they do. The bladder has amazing additional capacity. I close the mucosa first with a close continual mattress suture to allow for stretch, then close the mucosa with simple interrupted. That's just my technique and it works for me. I always inflate with saline afterwards to check for leaks but that goes without saying.

RE: Bladder leiomyoma

Joyce Whitehead — Tue, 27 Oct 2015 17:58:27 GMT

Thanks Gerry and Anthony, and good to know surgery would be feasible if needed. Definitely one I would refer in this case...

RE: Bladder leiomyoma

Gerry Polton — Tue, 27 Oct 2015 17:41:40 GMT

If the histological diagnosis is correct, this will be an intramural tumour so treatment from the intravesical aspect is not going to achieve much. Surgery is the treatment of choice. I would be surprised if it weren't feasible, even acknowledging the location within the bladder that you have stated. We operate on (selected) TCCs in this location and achieve far better outcomes than we ever did before we began operating on them.

Yours

Gerry

RE: Bladder leiomyoma

Anthony Dennison — Tue, 27 Oct 2015 17:18:14 GMT

Hi Joyce,

Something like this tumour could be a candidate for cystoscopic laser ablation? Needs repeating every so often; time frame depends on how quickly the tumour grows.