Examine the external surface for tumor. Attempt to identify the ureters, measure them, and submit the margins.
Submit the distal urethral resection margin.
Open the bladder with scissors (use a sharp blade for the prostate), making a Y-shaped incision through the anterior wall, beginning at the midline of the distal urethra and extending superiorly, then bifurcating (right and left) along the anterior bladder. Identify the ureteral orifices. The bladder may be pinned to a board and allowed to fix for a few hours before sectioning.
Measure (2 surface dimensions and 1 thickness dimension) and describe (color, ulceration, papillary vs. flat) the tumor. Note its location within the bladder and how deeply it penetrates the wall. Identify infiltration of adjacent structures (urethra, prostate, seminal vesicles, ureteral orifices, ureters). Ink the serosa if tumor is close. Transitional cell carcinoma is often multifocal, so check the “uninvolved” mucosa for other abnormal areas.
Follow the guideline and procedure for Radical Prostatectomy, if prostate is present; however, preserve the specimen in such a way that orientation is maintained, in case additional prostatic sections are required.
Measure and describe stones. Submit for chemical analysis, if requested.
Received without fixative/in formalin, labeled _____ and "_____", is a radical cystectomy/cystoprostatectomy specimen including an intact bladder (__ x __ x __ cm) with attached/detached bilateral ureter stumps (left = __ cm length and __ cm diameter; right = __ cm length and __ cm diameter) and attached/detached prostate (__ x __ x __ cm) with penile urethra (__ cm length and __ cm diameter). There is a _____ (color, shape, ulcerated) tumor (__ x __ cm surface x __ cm thickness) located ________. The tumor does not infiltrate/extends into the muscularis propria/extends into the serosa and is __ cm from the serosal margin/is at the inked serosal margin. There is a ____ (color, configuration, other features) area located _____ which is confined to the mucosal surface/infiltrates the _____ and is __ cm from the previously described tumor/__ cm from the serosal margin. The remainder of the mucosa is ____ (edematous, red); however, no other lesions are noted. The _____ ureter is without lesions. There is an area of _____ (__ x __ cm) in the ____ ureter, __ cm from the surgical margin. The ureteral orifices are patent/obstructed and uninvolved/involved by tumor. The prostate has a ____ (color) cut surface with multiple ____ (color) nodules measuring up to __ cm in diameter, mostly in the ______ (location) area. The seminal vesicles and vasa deferentia are without tumor or other abnormalities. Ink code: black = bladder serosa adjacent to tumor and posterior prostate; blue = right anterolateral prostate; yellow = left anterolateral prostate. Representatively submitted as follows:
#__ = urethra resection margin, en face; __ pieces.
#__ = right ureter resection margin, en face; __ pieces.
#__ = right ureter; __ pieces.
#__ = left ureter resection margin, en face; __ pieces.
#__ = left ureter; __ pieces.
#__ - #__ = tumor, full thickness; __ pieces in each.
#__ - #__ = ulcerated area from ____ (location)
#__ = bladder neck; __ pieces.
#__ = trigone; __ pieces.
#__ = anterior wall; __ pieces.
#__ = posterior wall; __ pieces.
#__ = dome; __ pieces.
#__ - #__ = right prostate, from distal to proximal; __ pieces in each.
#__ - #__ = left prostate, from distal to proximal; __ pieces in each.
#__ = right seminal vesicle and vas deferens; __ pieces.
#__ = left seminal vesicle and vas deferens; __ pieces.