Transurethral resection of bladder tumor (TURBT) is the primary procedure for treating non-invasive bladder cancer, used effectively for diagnosis and tumor removal.
This technique is minimally invasive, reducing risks and facilitating recovery time. Early intervention through TURBT is vital to improve and accelerate healing chances.
What is a bladder tumour?
Bladder tumour arises from the abnormal proliferation of cells in the bladder lining, leading to tumors that can be benign (non-cancerous) or malignant (cancerous). When the cancer is malignant, it can be classified into two types:
- Non-invasive tumors: These tumors typically remain within the bladder lining and are considered the most common form of bladder cancer. They are usually not life-threatening, although there is a slight possibility of them transforming into invasive tumors.
- Invasive tumors: These tumors represent types of cancer that grow into the bladder wall and may spread to other parts of the body.
What is Transurethral removal of bladder tumour (TURBT)?
Transurethral removal of bladder tumour (TURBT) is the first treatment typically performed for non-muscle-invasive bladder cancer. It is a surgical procedure used to diagnose and treat bladder tumors. The surgeon inserts a thin, rigid tube known as a cystoscope into the urethra. The cystoscope has fiber optics, a light, a camera, and a lens at one end, enabling the surgeon to view the tumor through the lens or on a TV screen.
The surgeon can locate and remove the tumor using small instruments passed through the cystoscope to cut the tumor from the bladder lining. This procedure does not require incisions; the tube is inserted through the urethra (where urine comes out) to reach the bladder.
After removing the tumor, it is sent to a lab where a pathologist will examine it. This test helps determine the stage (how far the tumor has grown into the bladder wall) and grade (how different the cells are from normal cells).
When is Transurethral removal of bladder tumour (TURBT) indicated?
Transurethral removal of bladder tumour (TURBT)is the primary treatment for bladder tumors. Benign tumors in the bladder typically grow very slowly; however, if left untreated, they can reach a large size and cause problems by occupying significant space in the bladder or pressing on other organs.
Malignant tumors continue to grow if not removed and may invade surrounding tissues and spread to other areas of the body, leading to additional complications. After the procedure, you will likely receive a single dose of chemotherapy injected into the bladder, which helps reduce the chance of cancer recurrence.
Symptoms that indicate the need for Transurethral removal of bladder tumour (TURBT) include:
- Presence of blood in urine
- Frequent urination
- Pain during urination
- Lower back pain
What is the Procedure for Transurethral removal of bladder tumour (TURBT)?
The procedure for transurethral removal of bladder tumour (TURBT) is usually performed under general anesthesia, meaning the patient will be asleep. Sometimes, spinal anesthesia may be used, which is an injection given in the epidural space that prevents the patient from feeling anything from the waist down. This procedure takes 15 to 90 minutes.
Preparation for Transurethral removal of bladder tumour (TURBT)
Before the Transurethral removal of bladder tumour (TURBT), the patient undergoes a comprehensive evaluation. Tests are typically conducted to check overall health and may include:
- Blood tests
- Electrocardiogram (ECG)
- Chest X-ray
The patient may be asked to provide a urine sample to check for infections. The doctor will prescribe antibiotics before the surgery if an infection is present.
The doctor will provide specific instructions on preparing for the Transurethral removal of bladder tumour (TURBT), as following these instructions can reduce the risk of complications. Before the Transurethral removal of bladder tumour (TURBT), the patient may be asked to:
- Do not eat anything for eight hours before the procedure (fasting)
- Stop taking medications before the procedure or take them with small sips of water, but do not stop taking any medications unless instructed
- Arrange for someone to drive them home after the procedure
- Shower before the procedure, and avoid any lotions, perfumes, or deodorants that day.
During the Transurethral removal of bladder tumour (TURBT) Procedure
Once the patient is asleep or spinal anesthesia is used, the surgeon inserts the cystoscope through the urethra into the bladder. Tumors are removed using surgical instruments passed through the cystoscope.
The surgeon may use a mild electrical current to stop the bleeding, known as cauterization. Any samples removed are sent for examination in the lab. In some cases, blue light cystoscopy or narrow-band imaging may be used during surgery to assist the doctor in removing the tumor(s).
After removing the cystoscope, a catheter is inserted through the urethra into the bladder. This catheter drains urine from the bladder into a collection bag and will remain in place until the blood in the urine decreases. The doctor may also use the catheter to irrigate the bladder with sterile saline. Some individuals may not need a catheter.
After Transurethral removal of bladder tumour (TURBT)
The patient should not feel pain during the Transurethral removal of the bladder tumour (TURBT). After the surgery, the patient may experience pain or discomfort, especially during urination, for one to two weeks.
Once the procedure is complete, the patient will be moved to a recovery area to rest after anesthesia. The nurse will monitor the patient and take regular measurements until the patient is fully awake. The patient can eat and drink normally. The patient may have a tube in the bladder (catheter) to drain urine into a collection bag for a short period. The nurse will remove the catheter before the patient leaves.
The patient may notice blood in the urine, which can last up to three days, and this does not prevent the patient from returning home. The doctor will advise the patient to drink plenty of fluids to flush the bladder, which helps prevent urinary tract infections. When the patient begins to urinate for the first time, they may feel burning and pain for several days. Pain relief medication will be provided to alleviate these symptoms.
If the patient received general anesthesia, they will need a companion to take them home and stay with them overnight. The patient should also avoid driving, consuming alcohol, operating heavy machinery, or signing any legally binding documents for 24 hours after the procedure.
The patient should notify the nurse immediately if they:
- Feeling that their bladder is full
- Experiencing discomfort in their abdomen
- Notice that the catheter has stopped draining
These symptoms usually improve within 1 to 2 days. If they do not improve, the patient should inform their doctor.
Alternatives to Transurethral removal of bladder tumour (TURBT) for Bladder Cancer Treatment
Transurethral removal of bladder tumour (TURBT) is the primary procedure for treating non-invasive bladder cancer. However, the doctor may recommend additional tests, such as computed tomography (CT) or magnetic resonance imaging (MRI) before or after the procedure to assess the extent of the cancer.
In cases where the cancer has invaded the muscle wall of the bladder or spread beyond it, there is a need to consider other treatment options, which include:
- Cystectomy: A surgical procedure to remove part of the bladder or the entire bladder, considered an option in advanced cases.
- Radiation Therapy: used to destroy cancer cells, especially when surgery is not possible or desired.
- Chemotherapy: Used to kill cancer cells and can be given before or after surgery or as a primary treatment in some cases.
It is essential to discuss these options with the treating physician to determine the most appropriate treatment plan based on the stage of cancer and overall health condition.
Potential Complications of Transurethral removal of bladder tumour (TURBT)
Transurethral removal of bladder tumour (TURBT) is considered a safe procedure. The nurse will inform the patient who to contact if they encounter any issues after the procedure, but the patient needs to be aware of the potential complications that may occur afterward.
Risks of Anesthesia
The patient may experience risks associated with anesthesia after Transurethral removal of bladder tumour (TURBT), such as allergic reactions or breathing issues.
Bleeding
The patient should contact the hospital immediately if any of the following occur:
- The bleeding worsens
- Blood clots appear in the urine
- Severe pain when urinating
- Inability to urinate accompanied by sharp pain
Infection
There is a risk of infection after Transurethral removal of bladder tumour (TURBT), and the patient should contact their doctor as they may need antibiotics to treat the infection. Symptoms may include:
- The need to urinate frequently
- Burning and tingling sensations when urinating
- Temperature rise
- Feeling hot and cold or chills
- Cloudy or foul-smelling urine
- General discomfort
Damage or Injury to the Bladder
Rarely, a small tear (perforation) or injury to the bladder may occur. This may require the use of a catheter for a few days to rest the bladder, and in very rare cases, the patient may need surgery to fix the issue.
Bruising and Swelling
A small bruise may appear around the area where the needle is inserted for the catheter. There is a rare risk of anesthetic or antibiotics leaking out of the vein, which can cause swelling and pain in the arm.
Not All Cancer Cells Are Removed
Not all cancer cells may be removed, or the cancer may return after transurethral removal of the bladder tumour (TURBT). The patient will undergo regular checkups after the procedure, and if there are any signs of cancer, further treatment will be offered.
Transurethral resection of bladder tumor (TURBT) is an essential and effective treatment step in controlling non-muscle-invasive bladder cancer, combining both diagnosis and treatment in a single procedure. Adhering to medical instructions before and after the operation helps reduce complications and accelerate recovery. Regular follow-up with the physician is crucial to ensure disease control and minimize the likelihood of recurrence.
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