pubmed/1574827.

28. Niknejad K, Plzak LS 3rd, Staskin DR, Loughlin KR. Autologous and synthetic urethral slings for female incontinence. Urol Clin North Am. 2002;29(3):597–611. https://doi.org/10.1016/

s0094- 0143(02)00074- 5.

29. Niu S, Didde RD, Schuchmann JK, Zoorob D. Gartner’s duct cysts: a review of surgical man­agement and a new technique using uorescein dye. Int Urogynecol J. 2020;31(1):55–61. https://doi.

bladder wall, it can be challenging to prevent bladder perforation, and complications after TURBT are inversely associated with body mass index (BMI) [17]. Yet, there are technical and anesthetic maneuvers to decrease the risk of per­foration. For each tumor resection or “swipe” of the electrocautery loop, the surgeon should attempt to identify the location of the normal bladder wall. Commonly, perforations occur when the loop is inadvertently extended past a tumor and touches the posterior wall. Perforations encountered during resection of lateral BCa are often caused by obturator nerve reex and can be mitigated by paralysis or careful resection with a “staccato” or tap-tap technique [18]. The staccato tapping of the cutting cautery can halt a resection that is deeper than anticipated, preventing a larger perforation. We recommend this stop-and-start or staccato technique to adjust the resection depth during each transurethral resection (TUR) swipe. Anterior perforations, secondary to bladder movement during breathing, can be prevented by stabilizing the bladder with the nondominant hand or controlling breathing with intubation. The thickness of the bladder, and therefore the depth of resection, can be managed by perform­ing the resection under limited bladder lling to decrease the wall tension. During a re-resection, in which a prior tumor area is mostly composed of scar tissue, perforation can be avoided by start­ing the swipe in a normal bladder area outside of the scar. Resection experience has been associ­ated with a higher risk of complications, with

TURBT performed by residents often associated with greater frequency. Finally, the use of bipolar energy has been associated with a lower risk of perforation (0.6% and 0.3%, odds ratio (OR)