Description
Most urologists, especially those in training, will have little experience or knowledge of how the laboratory prepares the material and the difficulties that can be encountered from poor requests to poorly fixed specimens and unrecognisable lumps of tissue. Squeezing a large testicular tumour into a jar and just putting in enough formalin to cover it will not results in good fixation, especially if left until the Monday. Failure to put a testis biopsy into Bouin’s solutions will also cause serious difficulties to the pathologist if the urologist wants to know about spermatogenesis and such mistakes on the part of the urologist and theatre staff must be corrected. What should the urologist do with a large tumour specimen just removed at 5pm on a Friday evening to ensure that the specimen is adequately fixed on Monday morning? Guidance is needed from the pathologist as to when the specimen needs sectioning first, sent fresh to the laboratory or a special fixation technique used. Nowhere in urology is this more important than with the fixation of a cystectomy specimen, Failure to distend the specimen with formalin shows a complete lack of understanding of the process that is required (Figure 1). Regular review meetings will ensure that this does not happen.
Much effort is spent by urologists in dissecting out lymph nodes when operating on urological cancers. This has prognostic and, in certain cases, therapeutic importance. In radical nephrectomies and radical cystectomies the nodes may be taken “en bloc”, The urologist may be well pleased with the clear field at the end of the dissection but unaware how difficult it may be to find those nodes again in the fixed specimen. A little extra time and effort to dissect off the nodes before fixation will be well worthwhile. The numbers of nodes found may be influenced by surgical technique or pathology technique. Pathologist and urologist must reach an understanding as to why the nodes are being sought and how it influences management and surgical technique.
