Transurethral = Through the urethra (tube through which urine exits the bladder)
Resection = cutting away or removal (some people refer to it as a “scraping”)
In short, a special scope termed a “cystoscope” is placed in the urethra and guided up into the bladder. The bladder tumor is cut away completely, or in other circumstances, just biopsied for analysis by the pathologists.
Most TURBTs are performed for transitional cell carcinoma (TCC), the most common type of bladder cancer. There are, however, other far less common types of tumors. In most instances, a TURBT is performed with the intent of removing the entire mass. In cases where the tumor is very extensive, we might only try to sample as much tissue as we need to properly determine the type and extent of the cancer to decide on the next plan of action.
As with any procedure in which anesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery. You may brush your teeth in the morning but not swallow the water. If you are on medications that must be taken, you will have discussed this with us and /or the anesthesiologist and instructions will have been given to you. The procedure will not be performed if you are currently taking, or have recently taken any medication that may interfere with your ability to clot your blood (“blood thinners, aspirin, anti-inflammatory medicines, etc.”). The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past ten days. If your new medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.
*It is to your advantage not to strain to have a bowel movement in the week after the procedure as it may cause bleeding in the urine. Try to avoid constipating foods in the week before your procedure. You should be eating lots of fruits and vegetables as well as oatmeal and cereals. If you have a known problem of constipation, you might administer an enema one hour before bed the night before your procedure.
To review the basics of what we discussed in the office: The actual procedure can take anywhere from 15 to 90 minutes (sometimes longer) depending on the location and size of the tumor.
You will be placed in lithotomy position (lying down on your back with your legs gently elevated in holsters call stirrups). The scope (which has continuous fluid running through it) is carefully inserted into the urethra and advanced into the bladder. We carefully examine the bladder to determine the extent of the tumor. Next, a special electric knife (termed a loop) is used to cut the tumor while simultaneously cauterizing (burning) the blood vessels. In some occasions, we use laser to assist in the procedure. Once the tumor is resected, we may take sample biopsies from uninvolved areas of the bladder or even from the inside of the urethra(prostate channel in men). After the resection is over, all of the tumor pieces (chips) are irrigated out of the bladder. In some cases (large tumors or apparently deep tumors), a catheter might be placed in the bladder to allow proper healing of the bladder wall.
Depending on the size of the tumor, and the extent of the resection, you might either be discharged home or admitted to the hospital. Depending on the circumstances, we may discharge you home with a catheter for a few days. It is normal for you to feel a strong sense of urgency to urinate. This is from the trauma to the bladder wall and possibly the presence of the catheter. In most patients, this goes away within a couple of hours. Some patients require medications to help relax the bladder while it is healing or while the catheter is in place. Patients may have no blood in the urine, mild blood, or even what appears to be a significant amount of blood or small clots. The blood usually disappears within a day or two. In most patients that are admitted, the catheter is removed the following morning and you are discharged home after you urinate on your own.
As previously mentioned, there are different reasons that a TURBT is performed. The most common scenario is that we intend to fully remove (scrape out) the tumor while simultaneously staging the tumor (determining how advanced or invasive the cancer is). In instances where the tumor is unable to be completely removed due to its size or location, we will sample as much as we need to properly stage the cancer, with the understanding that we may be recommending another form of treatment. There are instances in which we initially planned to resect the entire tumor, but realize during the procedure that this cannot be safely accomplished.
All surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. It is important that every patient be made aware of all possible outcomes which may include, but are not limited to:
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While UUANJ endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. UUANJ cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.