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Chapter 14: Table of Contents

2-Layer Closure

Bladder wall closure is performed in a single or double layer closure. For a double layer closure, perform a simple continuous appositional pattern (although it is recommended that the mucosa not be included in the suture bites, this is typically not possible for thin walled bladders). Then place a Lembert or Cushing inverting suture line to oversew the seromuscular layer. Alternatively, a single layer continuous closure can be performed. The single layer closure is preferred when the bladder wall is thick. Closure of the bladder incision is typically performed using rapidly absorbable monofilament suture such as Biosyn® and Monocryl®. Do not use Chromic gut or Dexon® (especially in infected urine) due to their extremely rapid loss of tensile strength in urine. A urinary catheter is not maintained in the postoperative period unless the repair/closure was tenuous and the bladder repair is likely to leak. In this instance, a soft catheter that does not protrude far beyond the level of the trigone is recommended.Urinary calculi should be submitted for analysis and for culture and sensitivity. Postoperative radiographs (with contrast if the calculi are not radioopaque) should be performed to confirm the removal of all urinary calculi. If calculi remain within the bladder or urethra, the patient should return to the OR for those to be removed.

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