Endoscopy | Bladder Biopsy & Tumor Resection (TURBT)

Description of Procedure

Trans = through

Uretheral = the urethra

Resection = surgical removal

Bladder

Tumor = abnormal growth of tissue

 

TURBT is a commonly performed, minimally invasive type of urology surgery. Usually done on an outpatient basis (daycare surgery), there is no cutting on the outside. Anesthesia ensures that there is no pain during the procedure by using sedation, spinal or general anesthetic. The instrument used is called a resectoscope which allows for the removal of tumor from the inside lining of the bladder.

 

The purpose of TURBT is to remove growths from the withinthe bladder - these can be both cancerous and non-cancerous. In some cases, a TURBT is required to obtain a sample and it is usually possible to remove the entire tumor. As a result, a TURBT is usually both diagnostic and curative. There are limitations to the depth of resection since the bladder wall is not particularly thick and perforation can be serious (especially through the dome into the peritoneum). A catheter may be left in place for a few days to a few weeks if the resection has been extensive.

 

The tissue that is removed is sent to the lab to confirm a diagnosis and also to determine the extent of the tumor growth - the most important characteristics for cancerous tumors are the depth of invasion into the wall follwed by the grade. 

 

Potential Complications

TURBT is not considered a major surgery and most symptoms are self limited with full recovery in days to weeks. However, as with any surgery there are risks, some of which are serious. Normal expectations are for there to be irritative urinary symptoms and some blood in the urine which gradually improves.

 

Uncommon but serious complications include

  1. Bladder perforation: usually managed with a catheter to drain the bladder for several weeks but may require open surgery to correct (the latter occurs in less than 1 in 100 cases)
  2. Obstruction of the ureters: in some cases resection of the ureteral orifices (where the kidneys drain into the bladder) is necessary to remove tumor - this is uncommon but may require re-implantation of the ureters with open surgery. Much less than 1 in 100 cases and less common than perforation
  3. Retrograde ejaculation: loss of antegrade ejaculation may occur in males where resection of tumor at the bladder neck is required.
  4. Bladder neck contracture: scarring of the bladder neck if extensive resection is required
  5. Urethral stricture: passage of the scope or the catheter may induce a scar within the pipe draining the bladder (urethra). This is usually managed with dilation but in rare cases the stricture may require formal repair with urethroplasty
  6. Incontinence: extensive resection of the bladder neck may result in loss of urinary control. This is very, very rare and if the possibility exists your urologist will discuss this with you.

After Procedure

If you have questions that are not answered here, please contact us.

 

What to Expect

 In general, temporary problems with passing of urine can occur following surgery and will gradually improve over 3-6 weeks. The following is considered NORMAL:

  •  Your stream should be strong unless you are passing small amounts of urine because of frequent urination.
  •  You may experience pain or discomfort when passing urine or at the end of urination. This may be intense for the first few days following surgery.

  •  You may experience blood in your urine, including blood clot and debris, for 3-6 weeks after surgery. The bleeding may appear heavy, but the blood loss is usually very small. Bleeding may be associated with activity.  If this occurs, rest and drink lots of water until urine clears.

  •  You may feel the need to pass urine frequently and urgently for several days or even weeks.

  •  You may experience occasional leakage of urine associated with urgency for several days.

  • You may feel tired and need to nap during the day for several days.

 

Cautions

Report any of the following to your doctor:

  •  You cannot pass urine.

  •  Fever over 38.5 C.

  •  Severe pain unrelieved by medication.

  • Catheter blocked or dislodged.

 

Diet

Advance to usual diet as tolerated. Avoid foods which constipate you.

 

  •  Certain foods may irritate your bladder while it heals, try to stay away from these: caffeine, pop, alcohol, spicy food.

 

  • Drink enough water to keep your urine reasonably clear, usually 8-10 glasses of water per day.

 

Activity

Get up and about as soon as possible after surgery.

  •  Walk as tolerated.

  •  Avoid lifting more than 30 lbs for 2 wks.

  •  You may start showering the day after surgery, even if you have a catheter. Do not submerge in a tub bath until the catheter is removed.

  •  If a catheter is in place, please review catheter care instructions.

  • Avoid driving while catheter is in place.

 

Medications

  •  Take antibiotics as prescribed.
  •  Use prescription pain medication as needed.
  •  Take a stool softener (obtain over the counter at local pharmacy) starting the night of your surgery.  Stop taking stool softeners once having soft bowel movements.  Do not take stool softeners if diarrhea occurs.
  •  If you have not had a bowel movement by the 3rd day after your surgery, take a laxative (obtain at your local pharmacy over the counter).
  • You may begin your regular medications when you leave the hospital unless instructed otherwise. If you are on blood thinners, your doctor will tell you when it is safe to resume them.

 

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