Transurethral Removal of Papilloma of the Bladder
Several years ago, a chance experience focused my attention on the possibilities of a new method for intravesical excision of papillary tumors of the bladder. A patient who was to have a transurethral resection for prostatic hypertrophy also had a small papilloma of the bladder. The tumor was approximately one centimeter in diameter and the pedicle was attached just above the right ureteral orifice. It occurred to me that this growth could be removed with the resectoscope at the time of operation on the prostate gland. Hence, when the prostatic resection was completed, the papilloma was engaged in the loop of the instrument. Two or three bites removed the tumor cleanly down to the bladder mucosa, and the base then was coagulated thoroughly. Cystoscopic examination several months later demonstrated that the growth had been removed completely, and there was no evidence of recurrence. These observations stimulated my interest in this method of treatment and, as a consequence, smaller pedunculated tumors of the bladder have been excised intravesically in this fashion in twenty-six instances during the last three years. A technic has been evolved which is applicable to tumors as large as 5 centimeters in diameter or, roughly, the size of a golf ball.
It is pertinent to this discussion to recall the fact that the cardinal symptom of papilloma of the bladder is blood in the urine. This usually appears spontaneously “out of the clear sky” and is seldom attended by burning, frequency, pain, or any other urinary symptoms. . .