Transurethral resection of bladder tumour (TURBT)
Transurethral resection of bladder tumour (TURBT)
TURBT is the surgical removal (resection) of bladder tumours. This procedure is both diagnostic and therapeutic. It is diagnostic because the surgeon removes the tumour and all additional tissue necessary for examination under a microscope (histological assessment). TURBT is also therapeutic because complete removal of all visible tumours is the treatment for this cancer. Complete and correct TURBT is essential for good prognosis. In some cases, a second surgery is required after several weeks.
TURBT is performed by the insertion of a rigid endoscope through the urethra into the bladder, with the patient under general anaesthesia (combination of intravenous drugs and inhaled gasses; you are ‘asleep’) or spinal anaesthesia (an injection is given in the lower back to numb the lower part of the body; you are awake). TURBT usually takes no longer than 1 hour and requires a short hospital stay. After the operation, a transurethral catheter is usually placed for a few days.
As in any surgical procedure, bleeding and infections may occur after the surgery. Symptomatic infections are treated with antibiotics and rarely require longer hospitalisation. Perforation of the bladder during the operation is not very common but can occur if the removal procedure goes too deep. Perforations usually resolve with catheterization for a few days; however, some cases require open surgery and suturing of the bladder.
Although TURBT can eradicate stage Ta or T1 tumours, some tumours commonly recur and can progress to invasive cancer. Washing the bladder with drugs to prevent the growth or spread of cancer cells (intravesical instillation) after TURBT should be considered for all patients. Instillation treatment is described later in the next section.
How is TURBT performed?
The procedure is usually performed under general or spinal anaesthesia (an injection is given in the lower back to numb the lower part of the body; you are awake).
A slender tube with a camera at the end is placed through the urethra into the bladder. All visible tumours are removed using a tool called a resectoscope, along with all additional tissue necessary for examination (biopsy). The cancerous tissue is scraped off, and any remaining cancer cells are burned away using an electric current that runs through the resectoscope.
How do I prepare for the procedure?
Your doctor will advise you in detail about how to prepare for the procedure. You must not eat, drink, or smoke for 6 hours before surgery to prepare for the anaesthesia. If you are taking any medication, discuss it with your doctor. You may need to stop taking medication for several days before surgery.
What are the risks of the procedure?
As with any surgical procedure, there are risks of complications:
- Perforation of the bladder wall is rare but can happen when the tumour is removed from deep within the bladder
- Blood in the urine
- Blockage of the urethra due to blood clots
- Damages to the bladder and urethra that can cause the formation of scare tissue and strictures (circular scars)
What happens after the procedure?
After surgery, a catheter is placed in the urethra to help stop the bleeding and to prevent blockage of the urethra. Irrigation fluid can be used to wash the bladder and catheter to prevent blood clots from forming. The catheter is removed when the bleeding has stopped. After the catheter has been removed and you are able to urinate without problems, you are released from hospital. This is usually 1–3 days after the procedure. Keep in mind that the length of hospital stay can vary between countries.
Your doctor will plan a follow-up visit 1–2 weeks after surgery to discuss the results from the biopsy.
Recommendations after surgery:
- You may have blood or blood clots in your urine for up to 3 weeks following surgery. This is normal and will pass.
- You may feel a constant urge to urinate. This will pass after a few days.
- You may feel a burning sensation during urination. This will pass after a few days.
- To help recover, it is important that you drink at least 2 L of fluids each day, especially water (avoid alcohol).
- Do not lift anything heavier than 2 kg 2 weeks after surgery.
- Refrain from sexual activity for up to 2 weeks.
- Avoid straining during bowel movement. Use laxatives if necessary.
- Do not cycle or exercise intensively.
- Avoid household chores such as window cleaning, vacuuming, or gardening.
- Do not use alcohol.
You need to go to your doctor or return to hospital:
- If a burning sensation during urination continues
- If your urines contains a lot of blood clots
- If you are unable to urinate
- If you are running a fever (higher than 37.8 degrees Celsius)
Residual tumour tissue is sometimes observed after removal of stage Ta and T1 tumours. Moreover, there is a risk that staging of these tumours after removal is too low (understaging) because the most aggressive part of the tumour has not been examined or has been missed during removal.
To achieve complete tumour removal and assess the correct stage of the tumour, your doctor will recommend re-TURBT 4–6 weeks after the primary TURBT in some cases.
Re-TURBT is recommended in the following situations:
- After incomplete initial TURBT
- No muscle is present in the tissue taken in the initial TURBT (unless tumours are low-grade stage Ta tumours or primary CIS)
- For all stage T1 tumours
- For all high-grade tumours (except primary CIS)
Re-TURBT is performed within 2–6 weeks after initial TURBT.