BLADDER NECK INCISION

ANTIBIOTIC:
Inj. Gentamycin 80mg
Anaesthesia :
Under spinal anaesthesia/ epidural anaesthesia
Position :
Patient is positioned on the table in a comfortable position
Skin preparation:
Usually cleaned with an antimicrobial solution (eg.betadine solution)
Begin at the umbilical region, covering at the pubic area, the inner thighs up to the anus.
Draping :
1 drape sheet under the buttocks
2 leggings, one for each leg
1 drape sheet over the andomen
Instrument :
• Cystoscopy sheath 22fr
• Bridge
• 30-degree telescope
• 0 degree telescope
• Cystoscopy sheath / BNI sheath (24fr / 26fr)
• Working element / resectoscope (forward moving finger grip) BNI knife
• Ball electrode
• Cable for resection
• Ellick evacuator
• Light source cable
• Camera
• Irrigation source / Y-connection
Miscellaneous things:
1. disposable syringe
2. xylocaine jelly 2%
3. foleys catheter 3 way
4. urobag
5. catheter introducer
6. normal saline
7. urethral dilators
urological procedure:
1. The objective is toproduce a single incision in the 7 0’clock position from just below the right ureteric orifice to alongside the vermontanum,

completely dividing all bladder neck fibres in the line of the incision through to the outer part of the capsule
2. the micro video operating system is particularly useful for this operation due to the magnified image on the video monitor, which encourage very

gentle strokes of the electrode as the bladder neck fibres pull apart
3. apply 2%xylocaine jelly per-urethrally

4. take the cystoscopy sheath 22fr and make the following connections

connect the bridge to the cystoscopy sheath
• insert the 30 degree telescope inside the cystoscopy sheath
• connect endo-camere to the telescope
• connect the light source to cystoscopy sheath
• connect the irrigation source

5. after all the connections have been made, the cystoscopy sheath will all the connections is inserted per-urethrally
6. visualize the urethra / vermontaneum / bladder and ureteric orifices.
7. remove the cystoscopy sheath and all the connections.
8. sometimes it may be required to dilate the urethra up to 26fr with the help of metal dilators for easy passage of the BNI sheath.
9. next the BNI cystoscopy sheath either 24fr (intermittent irrigation) / 26fr (continuous irrigation) is chosen depending on the surgeons choice, is

introduced per urethrally and its obturator is removed and the bladder emptied.
10. to the working element or the resectoscope the following connections are made.
• BNI knife / Collings knife
• 30 degree telescope
• Endocamera
• Light source
• Diathermy cable

11. the working element with the above connections are inserted through the 24 fr / 26 fr BNI sheath
12. the ureteric orifices are carefully identified with particular attention to the distances from the bladder neck.
13. the position of the verumontaneum is noted together wth the topography of any prostatic adenoma, which may influence theline of resection.
14. the bladder neck has the appearance of a wall of tissue preventing direct inspection of the bladder base.
15. the incision is started cautiously in the 7 0’clock position, just inside the internal urinary meatus, dividing the mucosa and exposing the bladder

neck fibres.
16. as the incision is deepened the bladder neck fibres can be seen to spring apart revealing further layers. They are progressively divided at this

level by delicate diathermy incision until the capsule is reached
17. this may be recognized by the sudden transition of a glistening translucent cobweb appearance to accompanying small globules fat
18. the incision is finally extended proximally to just below the right ureteric orifice and distally to alongside the verumontaneum
19. it should now be possible to view the base of the bladder vessels, which should be carefully sealed with the help of diathermy
20. if the mucasal bleeding troublesome this may be conviently dealt with a roller ball electrode
21. next remove the working element will all connections leaving the BNI sheath per urethrally
22. with the help of the ellick’s evacuator connected to the sheath, a bladder wash is done to remove clots
23. then put in the obturator and remove the BNI sheath
24. a 3 way urethral catheter is inserted per urethrally with the help of a catheter introducer ( 3-way for irrigation)
25. irrigation can be removed either on the 1st or 2nd post operative day depending on the patients condition.