"Turn your head and cough, please!" Day 14- I feel nothing in that area

Another day at work breaking my back.

Since I didn't take any pics today and I love pictures in posts, thought I'd add a bit of the hilarious Kevin Hart to the mix for what might be a painful subject for some men.

I asked the other elective if she wanted to be in the OR this week but she said she was quite comfy on the wards.

There are multiple factors as to way my back hurt so much toady. The biggest factor is probably that of the 6 hour operation I was really only doing something 2.5 hours of it while the rest was spent standing there. Like I've said before, you could put in me in a room and make me stand there for 6 hours and it would be about the same (except for the sometimes humorous conversations that were had between the attending and male OR nurse).

If you had filmed me the 5 hours and then played it back in high speed, it would have looked like I was doing some crazy tribal dance. I tried stretching and moving my legs and back through out the whole operation to ease the pain.

Since I had nothing else to focus on I am sure my back hurt even more (or at least I noticed it more).

I'm just so dang tall! Dr.H already has to stand on a little step because he is shorter than Dr.S. But I'm about half a head taller than Dr.S. Of course the whole team isn't going to get up on steps just to equal out my height. This however makes everything worse on my lower back.

The attendings were stretching too but not as much (they were focused on operating). I'm just starting to get sick of this standing around and occasionally holding a hook (I am fully aware I have a lot more of these operations ahead of me.)

Weird, I feel nothing in that area.
So what did we operate for 6 hours?



The patient had bladder cancer and the bladder had to be removed along with the urethra.

Histology side note: Urothelium are the cells that make up the lining of the urine transporting surfaces. It is different from any other epithelium in the body. It starts in the kidneys and ends (by men) a bit before the urethra exits the body. (the yellow in my drawn pics further below) Since this patient's cancer was invasive the urothelium a saftey distance above and all below the tumor had to be removed.

The whole bladder is removed. The ureters (leading from the kidneys to the bladder) were cut and sent to pathology to make sure we were well above the tumor. The ureter ends were sewn to the outside of the stomach so that the urine could empty into bags.

I've seen a few bladders removed so far but the urethra wasn't removed in the ones I saw. This was the first one and it was kinda fun to watch (the male nurses in the room did not feel the same amusement and had sympathy with what the patient wasn't feeling due to anesthesia.)

I tried to think of the best way to explain the urethra removal to y'all but it's difficult in 2D but I decided to draw a sketch. Basically, the penis is turned inside out. Let me (try to) explain.

The stomach was cut open to get access to the ureters, bladder and the first part of the urethra. Once the urethra leaves the body through the penis out of the body you can't access it all the way through the end. So the exit of the penis gets exposed between the symphysis (part of the hip bones) and the skin. It is turned inside out and the urethra can be cut out and the penis can be turned right side out again. (The cringing of the male nurses at times was entertaining. I felt nothing haha)

So....The normal anatomy (very simplified from reality and obviously we aren't usually green on the inside and look like a pole with a penis in real life)

 The stomach is cut open and held open with hooks to get access to the bladder (and a lot of other slimy things)

Just for better visualization and not to indicate an erection during operation, the following drawing:

And now the inside-out maneuver:

The yellow in the picture can all be removed and the penis put back into place and the patient sewn back up and voila. (A LOT easier said than done)

Since there will be a lack of doctors tomorrow and another DaVinci is planned I assume I'll be helping out in outpatient or on the ward tomorrow. Hopefully a bit more back friendly :)

Baci, V