Bladder lesion removal
Bladder lesions, such as tumours or growths, are removed in an operation called a trans urethral resection of bladder tumour or "TURBT".
It is usually performed under either a spinal or a general anaesthetic. In either case, you will feel no pain throughout the procedure. With a spinal anaesthetic you will be conscious; with a general anaesthetic you will be asleep.
You will normally need to stay in hospital overnight.This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Your specialist or hospital will give you some information about when and how to check into hospital.
Before you come into hospital, you may also be asked to:
- Have a bath or shower at home on the day of your admission,
- Remove any make-up, nail varnish and bulky or sharp jewellery. Rings and earrings that you'd prefer not to remove can usually be covered with adhesive tape,
- Follow the fasting instructions in your admission confirmation letter. Typically, you must not eat or drink for about six hours before a general anaesthetic operation. However, some anaesthetists allow occasional sips of water until two hours beforehand.
When you arrive at the hospital, your nurse will explain more about how you will be cared for during your stay. Your specialist and anaesthetist will also visit you. This is a good time to ask any outstanding questions about your treatment.
You will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead.
The procedure involves inserting a narrow, flexible instrument called a cystoscope into the bladder through the urethra – the pipe that carries urine from the bladder to the outside of the body. This lets your specialist see inside the bladder. It also allows tiny surgical instruments to be passed through.
Using these instruments, the tumour is cut away. Some of the healthy tissue around the tumour may also be removed to make sure that no part of the tumour is left behind. The area is sealed using an electrical current (diathermy) to stop the bleeding.
The cystoscope is then removed and a catheter (a narrow flexible tube) is passed up the urethra to drain urine from the bladder into a bag outside the body.
Part of the tumour will be sent for laboratory analysis. Most bladder tumours are cancerous, and the analysis will show what "grade" (how aggressive) the cancer is and whether further treatment will be required. Simply removing them may be all that's needed.
The procedure usually lasts about 30 minutes (slightly longer if more than one tumour is present).
You will be taken from the operating theatre to a recovery room, where you will come round from the anaesthetic under close supervision. After this, you will return to your room.
Back on the ward
Your nurse will monitor your blood pressure and pulse at regular intervals. Once the effects of the anaesthetic have passed you may feel a bit sore, although it is uncommon to feel a lot of pain after a TURBT. Mild painkillers are usually all that is required. Please discuss pain relief with your nurse, specialist or anaesthetist.
When you feel ready, you can begin to drink and eat, starting with clear fluids such as water, or apple juice.
The catheter will drain urine from your bladder into a bag. For the first 24 hours, the catheter will also be connected to an irrigation system that washes any blood and blood clots out of the bladder. The presence of the catheter may be a bit uncomfortable. You may be given antibiotics to help prevent infection.
In some people, as a precaution, chemotherapy drugs may also be given via the catheter the day after the operation. This is to eliminate any stray cells that may have been shed during the operation. It may also help reduce the chances that you will get another bladder tumour. This form of chemotherapy does not affect your whole body and so does not have major side-effects (such as hair loss or feeling sick).
After this, the catheter will be removed, and once you have passed urine you will be able to go home.
Before you go home, the nurse will advise you about looking after yourself. The nurse will also give you a contact telephone number for the hospital, in case you need to ask for any further advice, and may make an appointment for you to visit the outpatient clinic.
After you return home
If antibiotics have been prescribed, it's important to complete the whole course. If you need them, continue to take painkillers as advised by the hospital.
You will be able to manage stairs, but will need to avoid strenuous exercise and heavy lifting (such as carrying children or heavy shopping) for the first two weeks. You should gradually increase your level of activity each day, but ensure you have a rest between each period of activity.
Your specialist will advise you when to return to work. This will depend on your occupation, but you are likely to be off work for about two weeks, or longer if your job is strenuous. You should not drive until you feel able to carry out an emergency stop.
Try to drink at least two litres of fluid, preferably water, every day. This dilutes the urine and helps reduce any burning sensation on passing urine.
You should try to avoid constipation, as straining may increase bleeding. Eat a high fibre diet including plenty of fruit, vegetables and wholegrains. If required, a mild laxative, such as lactulose or senna, may be used according to the instructions.
Sexual activity may be resumed when you feel comfortable, but you are more at risk of urinary infections for a few weeks. Emptying the bladder after intercourse can help reduce this risk.
Contact the hospital or your GP immediately if you notice:
- Increasing amount of blood in the urine,
- Increasing discomfort in passing urine,
- Inability to pass urine,
Removal of a bladder tumour is a commonly performed and generally safe surgical procedure. However, all surgery does carry some element of risk. This can be divided into the risk of side-effects and the risk of complications.
These are the unwanted but mostly temporary effects of a successful treatment. Examples of side-effects include feeling sick as a result of the general anaesthetic. After the catheter is removed there is likely to be some discomfort in the urethra, especially when passing urine, but this should settle after about 48 hours. There may be some blood in the urine for 10-14 days.
This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, bleeding during or soon after the operation, or infection.
In addition, specific complications of having a TURBT may include:
- Blockage of the catheter, caused by blood clots. This is resolved by a simple procedure called a "bladder wash-out".
- Urinary tract infection. The risk of this is higher for a few weeks after the operation. It is treated with antibiotics.
The chance of complications varies depending on the exact type of operation and factors such as your general health. You should ask your specialist to explain how these risks apply to you.
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