In transurethral resection of bladder tumour (TURBT), special instruments are passed into the bladder via a telescope called a cystoscope. The tumour is cut out using these instruments and the pieces are extracted via the cystoscope. The area around the cancer is then cauterized (burned) to prevent excessive bleeding. A pathologist then examines the tumour pieces under a microscope. This allows us to determine the grade and stage of the tumour, and therefore plan further management.
Before Your Surgery
Certain medications increase the risk of bleeding and need to be stopped prior to surgery. You should tell your surgeon about all prescription medicines, over the counter medicines, vitamins, and herbal supplements that you are taking. Some patients, such as those with artificial heart valves or high blood clotting risk, will need to take blood-thinning injections whilst coming off their tablet medications.
After Your Surgery
After your surgery, you will arrive at the Post-Anesthesia Care Unit (PACU) where the recovery room nurses will monitor your condition. Once you have recovered sufficiently from the anaesthesia, they will transfer you to the ward. Whilst you are still under anesthesia, the surgeon may place a special catheter through your urethra into your bladder. This allows for constant irrigation into the bladder to prevent blood clots from forming. The ward nurses will remove the catheter either later in the day or the following morning. After removal of the catheter, you may initially experience some urgency, frequency, stinging, and dribbling. Expect to still have blood in your urine at this stage. Patients undergoing TURBT for small tumours or simple biopsies may go home the same day. Larger tumours require admission to the hospital for bladder washout with a catheter.
Recovering at Home
As healing continues, you may notice blood in your urine off and on for several weeks after your operation. When bleeding occurs, drink plenty of water until the urine clears, then reduce your fluid intake to normal. Avoid constipation, as straining may cause bleeding from the operation site in the bladder. Return to your normal diet but with added bran and fruits. A mild laxative such as Nulax or Metamucil can be used if necessary. No driving for one week after surgery. Avoid heavy lifting, bending, stretching, or straining activities like mowing the lawn for up to four weeks after your surgery. You may resume walking or light exercise immediately after your procedure. Ask your surgeon when to recommence blood-thinning medications.
Specific Risks and Side Effects of TURBT
- Prolonged or heavy bleeding may sometimes occur. Delayed bleeding 7 to 10 days after the procedure occurs when the scab at the site of tumour resection lifts. Manage this by increasing fluid intake.
- Urinary tract infection requiring treatment with antibiotics.
- Difficulty with urination including stinging, burning, or discomfort.
- Inability to pass urine (urinary retention) due to passage of blood clots or swelling of the urethra or prostate after surgery.
- This may require temporary reinsertion of the urinary catheter.
- Internal scarring in the urethra (stricture or bladder neck contracture), which may require further surgery.
- Injuries to the bladder wall may require insertion of a urinary catheter for a few days, and very rarely need major reconstruction.
- Anaesthetic complications, such as heart attack or stroke.
- Infection, for example of the urinary tract, chest, or other sites.
- Bleeding which may occasionally require a blood transfusion.
- Clots forming in the legs (DVT), which may then pass to the lungs.
- Allergic reactions to drugs, antiseptics, or wound dressings.
- Death is extremely rare after any surgical procedure. The risk of death relates to the patient’s general health and the complexity of the surgery, and may arise due to either anaesthetic or surgical complications.
When to contact your surgeon
- Heavy bleeding, with clots in the urine.
- Difficulty emptying the bladder, or unexplained leakage.
- If you develop an infection – this can present with a temperature, smelly urine, or burning and stinging when passing urine.