Saturday, June 19, 2010

Transurethral resection of bladder tumour (TURBT)

Published by Bupa's health information team, December 2008.

Transurethral resection of bladder tumour (TURBT) is a procedure used to diagnose bladder cancer and remove unusual growths or tumours on the bladder wall.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

The most common type of bladder cancer is caused by the uncontrolled growth of the cells lining the bladder wall. If the cancer hasn't grown from the bladder lining into the muscle of the bladder it is called superficial or non-muscle invasive. Superficial bladder cancer can be treated by removing it from the bladder wall. The procedure is called transurethral resection of bladder tumour (TURBT).

What are the alternatives?
Your surgeon may recommend TURBT to remove unusual growths or tumours on the bladder wall. Alternatively, the bladder may be treated with mitomycin C or Bacille Calmette-Guérin (BCG) vaccine on its own or as well as surgery.

Preparing for your operation
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
TURBT usually requires a hospital stay of one to two days and is routinely done under general anaesthesia. This means you will be asleep during the procedure. Alternatively, you may prefer to have the surgery under regional anaesthesia. This completely blocks feeling from the waist down and you stay awake. A sedative may be given with regional anaesthesia to help you relax during the procedure. Your surgeon will advise which type of anaesthesia is most suitable for you.
If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine.
Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

About the operation
The operation can take up to one hour.
A thin, rigid, tube-like telescope called a cystoscope is carefully passed into your urethra (the tube that carries urine from the bladder to the outside) and into the bladder.
Sterile fluid is passed through the cystoscope into the bladder. This makes the bladder wall easier to see.
A camera lens at the end of the cystoscope sends pictures from the inside of your bladder to a video monitor. Your surgeon will look at these images to locate the unusual growth or tumours on the bladder wall.
Your surgeon will insert a special wire loop through the cystoscope and pass an electric current down the wire loop. The electric current is used to cut or burn off the growth/tumour and a border of healthy tissue around it. The electric current seals the wound so stitches are not needed.
The cystoscope is taken out and a thin flexible tube (catheter) is passed into the urethra and left in place for about 24 hours. The catheter drains urine from your bladder into a bag.
The removed tissue is sent to a laboratory for tests.

What to expect afterwards
You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
Your nurse will check your catheter and monitor your blood pressure and heart rate. The catheter may be connected to a system which washes any blood and blood clots out of your bladder. This is called bladder irrigation.
You may be given chemotherapy medicines through the catheter to try to prevent the cancer from returning. You may also be given antibiotics to help prevent infection.
The catheter is usually removed before you go home. You will be given a date for a follow-up appointment before going home.
You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from TURBT
If you have been prescribed antibiotics, it's important to complete the whole course.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.
You will have some blood in the urine for up to three weeks and you are more likely to develop a bladder or urinary tract infection (UTI) until the bladder fully heals. Drink plenty of clear fluids to help flush your bladder and reduce your risk of infection.
Contact your GP if you develop any of the following symptoms, as you may have developed an infection:
  • severe pain or pain that lasts for more than 48 hours
  • high temperature
  • burning sensation on passing urine or if your urine starts to smell
  • heavy blood-stained urine with clots
Bladder tumours often come back so you will need to have regular cystoscopy checkups.

What are the risks?
TURBT is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

These are the unwanted but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.
Side-effects of TURBT include:
  • pain and discomfort in your bladder and urethra - this usually settles after 48 hours
  • blood in urine - this may last up to three weeks

This is when problems occur during or after the procedure. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Complications of TURBT are uncommon, but can include:
  • urinary tract or bladder infection (cystitis) - antibiotics are usually given to help prevent this
  • difficulty in passing urine - a catheter is usually used for the first 24 hours
  • damage to the urethra, bladder or bladder wall - you may require further surgery
  • blockage of the urethra - blood clots can block the urethra and you may need a temporary catheter or further surgery to remove the clot
  • repeat TURBT - if the tumour isn't completely removed or it re-occurs you may need a repeat TURBT
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
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1 comment:

sarilskins said...

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