Cystectomy or Cystoprostatectomy

Triage

  1. Measure specimen, overall.
  2. Measure bladder and length of ureter stumps.
  3. If prostate is attached, measure prostate, seminal vesicles and vasa deferentia.
  4. Ink peri-cystic adipose tissue: left black, right blue.
  5. Ink prostate if attached: left black, right blue.
  6. Take all margins fresh and keep cassettes in specimen container (VERIFY FRESH MARGIN SECTIONS WITH A PA, SPECIFICALLY URETERS):
    • Trim and submit bilateral ureteral margins en face, designating left and right.
    • If prostate is attached, gently pull out prostatic urethral mucosa, trim, and submit en face.
    • If there is no prostate, trim and submit circumferential urethral margin en face.
    • If prostate is attached, trim, serially section and submit apical margin. (If you don’t have time, you can shave the prostate margin and section it the following day).
  7. Orient specimen and open the bladder anteriorly through the prostatic urethra and continue toward the dome in a Y-shaped cut.
  8. Measure mass or ulcerated lesions.
  9. Photograph opened specimen to show extent of lesion.
  10. Pin specimen and fix overnight in formalin.

Gross

  1. Examine external surface and look for lymph nodes.
  2. Examine mucosal surface. Identify lesions and describe size, location, ulceration, nodularity.
  3. Make serial, transverse, transmural sections beginning at bladder neck (or apex of prostate, if attached) and proceeding to dome.
  4. Measure greatest depth of invasion and closest extent to inked margin.
  5. Photograph a section to show deepest invasion.
  6. Tumor submission:
    • For ulcers with induration (firm area suspicious for residual tumor), submit entirely. For other ulcers, submit peripheral rim including ulcer and surrounding bladder mucosa.
    • For grossly evident tumors, submit representative sections demonstating deepest tumor extention into wall (including inked black resection margin) and well as adjacent uninvolved bladder.  Also submit representative sections of uninvolved bladder, seminal vesicles, any identified lymph nodes, and prostate parenchyma.