Transurethral Resection Of Bladder Tumour (TURBT)

What is a TURBT?

It means that the growth in your bladder will be removed Endoscopically. The bladder is a muscular, hollow, balloon-type organ situated in the lower abdomen. Urine travels from the kidneys to the bladder via tubes called ureters. When the bladder is full, the urine passes out of the body through a tube called the urethra. The urethra opens at the tip of the penis in men.

How is a TURBT performed?

The operation is performed under general or local anaesthesia. The operation is performed through a telescope passed along the water pipe (urethra) with no external cuts or scars. An electrical loop is used to cut away small parts of the tumour until it has been completely removed. The pieces of the bladder tumour are sent away to the lab for examination.

At the end of the operation, a catheter is left in the bladder, which drains the urine and helps to wash away any blood. This catheter stays in for 24-48 hours.

What type of anaesthetic will I have?

The anaesthetist will visit you before the operation to discuss the alternatives. The anaesthetist will also check that you are fit enough for the anaesthetic. A TURBT is usually done with a general anaesthetic (asleep) or a spinal anaesthetic (an injection in the back to make you numb from the waist down).

Getting ready for the operation

If you smoke, try and cut down or preferably stop, reducing the risks of heart and chest complications during and after the operation. If you do not exercise regularly, try and do so for at least half an hour per day, e.g. brisk walk or swimming.

You will be sent an appointment to visit the pre-assessment clinic a few days before your operation date. This is a general health check to ensure you are fit for surgery. The pre-assessment nurse will organise for you to have blood taken and have an ECG (heart tracing) and answer any questions that you may have.

What are the risks, consequences and alternatives associated with having a TURBT?

Most procedures are straightforward; however, there is a chance of side effects or complications, as with any surgical procedure.

Common

• Temporary mild burning, bleeding or frequency of urination after the procedure
• Need for additional treatments to the bladder in an attempt to prevent recurrence of tumours, including drugs instilled into the bladder

Occasional

• Urine infection requiring antibiotics
• No guarantee of cancer cure by this operation alone
• Recurrence of bladder tumour and/or incomplete removal

Rare

• Delayed bleeding requiring removal of clots or further surgery
• Damage to drainage tubes from kidneys (ureters) requiring additional therapy
• Injury to the urethra causing delayed scar formation
• Perforation of the bladder requires temporary insertion of a catheter or open surgical repair

Alternatives to TURBT

• Open surgical removal of the bladder
• Chemotherapy
• Radiotherapy

What should I expect after the operation?

After your operation, you will normally go back to the urology ward. You can start eating and drinking as soon as you recover from the anaesthetic.

We often give a bladder treatment after this kind of operation. A drug (mitomycin-C) is flushed into the bladder through the catheter to reduce the risk of other tumours growing in the future.

Pain

• Because there are no external cuts, this procedure is relatively pain-free. You may experience some discomfort from the catheter, but this is usually easily treated with mild painkillers (e.g. Paracetamol).

Catheter

• A urinary catheter is a tube that runs from the bladder out through the tip of the penis and drains into a bag. It is important to drain the urine until the urine is as clear. Your catheter is usually removed 24-48 hours after your operation.
• Once the catheter has been removed and you are passing water normally, you will be able to go home.

Discharge information and home advice

Bleeding

• It is quite normal to see an occasional show of blood after discharge. This is due to the healing of the operation site. If you see blood, simply increase your fluid intake. If you have prolonged bleeding or increasing difficulty passing water, please contact the hospital.

Pain

• Mild painkillers such as Paracetamol should be enough to deal with any pain.

Exercise

• It would be best to take it easy for a month, although it is important to do some gentle exercise like walking, as you will be slightly at risk of developing a blood clot in your legs. During the first four weeks, you should not:
• Lift or move heavy objects
• Carry shopping

Work

• Recovery takes 6-8 weeks from your operation date. Your doctor will be able to advise you when it will be safe to return to work as this depends on your occupation. The nurse can provide a sick note for your hospital stay.