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A. Transurethral resection of bladder tumour (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.
A. A cystoscopy is often used to detect the presence of bladder cancer. If there is cancer, a TURBT is performed to remove the tumour and to determine whether it has spread to the muscle layer of the bladder wall. This operation involves the telescopic removal of the malignant tissue with heat diathermy and temporary insertion of a catheter for bladder irrigation.
A. If you are a smoker, we advise you to stop smoking straight away.
If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. Aspirin does not usually need to be stopped but will be the decision of your surgeon.
You will usually be admitted on the same day as your surgery, or a day before. You will normally undergo pre assessment on the day of your clinic. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
A. Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.
A telescope is passed into the bladder and a thorough visual inspection (Cystoscopy) is performed. This is followed by removal of the malignant tissue using heat diathermy. The tumor chips are evacuated using suction and sent for pathological analysis. A catheter is usually inserted after the procedure. The catheter may be used to administer local chemotherapy into your bladder immediately after the procedure. It is left in your bladder for an hour then drained afterwards.
The procedure takes 45 to 60 minutes.
You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Common (greater than one in 10)
Occasional (between one in 10 and one in 50)
Rare (less than one in 50)
A. There are several measures that can help you prevent complications such as:
A. The catheter is generally removed after two to three days, following which urine can be passed in the normal way. In case there has been deep resection then catheter will be kept for seven to ten days.
At first, it may be painful to pass your urine and it may come more frequently than normal. Any initial discomfort can be relieved by tablets or injections and the frequency usually improves within a few days.
A. The average hospital stay is usually 36 to 48 hours.
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
Most patients feel tired and below par for a week or two because this is major surgery. Over this period, any frequency usually settles gradually.
A. If you experience increasing frequency, burning or difficulty on passing urine or worrying bleeding, contact your urologist.
In the event of severe bleeding, passage of clots or sudden difficulty in passing urine, you should contact your urologist immediately since it may be necessary for you to be re-admitted to hospital.
A. Your biopsy report will be available in 10 to 14 days. Depending on the biopsy results, further investigations (eg x-ray, CT scan), instillation of drugs into your bladder (chemotherapy or immunotherapy) or a further admission may be arranged for you.
A. The symptoms of an overactive bladder may take three months to resolve whereas the flow is improved immediately. Sexual activity can be resumed as soon as you are comfortable, usually after three to four weeks.
Most patients require a recovery period of two to three weeks at home before they feel ready for work. We recommend three to four weeks rest before resuming any job, especially if it is physically strenuous and you should avoid any heavy lifting during this time.
A. 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 (under-staging) 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, re-TURBT is recommended 4–6 weeks after the primary TURBT in some cases: