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Trans-Urethral Resection of Bladder Tumour

Trans-Urethral Resection of Bladder Tumour (TURBT)

If an abnormal area or probable cancer has been seen within the bladder, the most important treatment initially is to have the area removed and a small tissue sample taken away for analysis (biopsy).

TURBT is performed under general anaesthetic and will involve about 3 days stay in hospital. The procedure is performed through the resectoscope and does not involve any external cuts.

An operation is needed to remove the tumour, to assess grade and stage of the disease.

Before the operation:

You should have nothing to eat 6 hours before the operation, but you can drink water up to 2 hours before your operation.

If you are on anti-coagulation therapy (aspirin, warfarin and clopidogrel) you should stop taking them 3-10 days, espectively, before your operation. Speak to your anti-coagulation nurse about this.

During the operation:

A resectoscope is inserted via the urethra into the bladder. Using this instrument, the urologist is able to inspect the lining of the bladder. The resectoscope uses an electrified wire loop to remove areas of tissue from the bladder wall and allows blood vessels to be cauterised (sealed) to reduce the risk of bleeding afterwards.

The abnormal area is sent to the laboratory to be looked at under the microscope by a pathologist, who will determine what type of tumour it is - a procedure known as histology. This can take 3-5 days to be reported.

A catheter that drains urine from the bladder will be inserted during the operation. It is normal for the urine to be blood-stained. An irrigation fluid is often run through the catheter to wash out the bladder and prevent clots forming. The catheter normally stays in place until the draining urine is clear or rosé. After the catheter is removed, the amount of urine passed and your bladder residual after urinating is measured to ensure you are able to pass good amount of urine.

The morning after the operation, some people may also have a single dose of chemotherapy (Mitomycin) given directly into the bladder.

Potential Risks of TURBT:

  • Urinary tract infection: (approximately 4% of patients). This usually occurs immediately after the operation or when at home. Prophylactic antibiotics are given at the time of the operation to minimise this risk.
  • Haematuria: It is expected to experience a slight episode of haematuria or blood-stained urine around 10 to 14 days after the operation. This occurs when the scab that forms in the bladder after the tumour is resected falls off and breaks in the urine. In this case, increasing your fluid intake to flush out the bladder is necessary. Sometimes a more substantial bleed may occur at this time if on anticoagulants or have urinary tract infection. It is recommended you see your Urologist or Urology CNS to perform a bladder wash out and urine culture taken to exclude urinary tract infection (UTI). Ensure anticoagulants are stopped 3-10 days before your surgery.
  • Damage to the bladder wall and urethra - this may require the catheter to stay in longer to allow any weakened area to heal.
  • Formation of urethral stricture - a fibrous scar in the urethra may form after surgery (less than 1% of patients). This may require corrective surgery in the future.
  • Unable to pass urine after catheter removal - urinary retention occurs in approximately 5% of patients. A catheter would be reinserted and stay in place for a few days.