Bladder Tumour Resection
Please refer to the detailed information provided by the rooms. This information is also available on the website. 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).
The actual procedure can take anywhere from 15 to 90 minutes (sometimes longer) depending on the location and the size of the tumour. You will be placed in lithotomy position (lying down on your back with your legs gently elevated in holsters called stirrups). The scope (which has continuous fluid running through it) is carefully inserted into the urethra and advanced into the bladder. We examine the bladder to determine the extent of the tumour. Next, a special electric knife (termed a loop) is used to cut the tumour while simultaneously cauterizing (burning) the blood vessels. After the resection is over, all of the tumour pieces (chips) are irrigated out of the bladder. Because there is often some bleeding after the procedure, a catheter may be left in place through which fluid irrigation flushes out any blood. This is usually left in place for 1-2 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. Any bleeding seen in the fluid coming out of the catheter 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. Within 24hrs of removal of the tumour, you may receive a dose of chemotherapy which will be placed via the catheter directly into your bladder. This chemotherapy agent, Mitomycin C, can reduce the risk of tumour recurrence by up to 40%.
Possible Complications of the Procedure
The vast majority of patients will not experience any problem after a bladder tumour resection. However, any procedure, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. These may include, but are not limited to:
If the cutting is deep, the wall of the bladder can be perforated. This is far more common in large tumours or those that are at an advanced stage (deeply invading the wall of the bladder). It is also more common in the elderly, where the bladder wall may be quite thin. In most cases, we need to leave the catheter in for an extra few days to allow self-healing. Sometimes we may need to perform a bladder repair through an incision in the abdomen.
Haematuria / Clot Retention / Transfusion
As we cut away the tumour, small blood vessels (arteries and veins) are cut and bleed. Throughout the entire procedure, we cauterize (burn) the vessels shut. At the end of the procedure, we carefully inspect the area to ensure that there is no significant bleeding. There are always some minor, insignificant vessels that slowly ooze. Rarely, a scab of a vessel we cauterized can fall off and cause significant haematuria (blood in the urine). This may occur a few days or even weeks after the operation. In most cases,this bleeding settles with nothing more than an increase in oral fluid intake. If clots form, it can block the urethra or the catheter and we may need to irrigate the clots out. Rarely, we would have to return to the operating room to put the scope back inside the bladder and re-cauterize the blood vessels. If bleeding is prolonged during or after the operation, we may need to check your blood count. It is rare to need a blood transfusion following a TURBT.
Urinary Tract Infection or Urosepsis (Bloodstream Infection)
Before this procedure can take place, we must confirm that you do not have an active urinary tract infection. If a urinary tract infection is not present, it is most unlikely that you will suffer sepsis after this procedure. In the rare event that you do, you will be given intravenous and oral antibiotics. This scenario is more common in diabetics, patients on long-term steroids, or in patients with disorders of the immune system.
In a male, pressure from the scope can occasionally cause inflammation in large and/or obstructing prostates. It may block the flow of urine and cause retention (inability to urinate or empty the bladder). In many circumstances, it resolves with a catheter over the next few days. Less commonly are medications or a prostate procedure required.
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. You may see him in his offices at RPA, Bankstown or Strathfield Private Hospital. Do not hesitate to call at any time if you have any concerns.