Resectoscope in male pelvis
Bladder tumour with resectoscope loop
TUR Bladder Tumour
The standard initial operation for bladder cancer
This is the operation used to remove tumours from within the bladder. These tumours can be either malignant (a cancer) or benign and the full extent of the problem will not be available until after the tumour has been analysed under a microscope (histology).
It is hoped that these notes will help you in preparation for the operation. If you have any questions please do not hesitate to ask your doctor.
What is the bladder?
The bladder is a sac of muscle that both collects and stores urine from the kidneys and then expels it through the urethra – see pictures. It lies in the pelvis and has slightly different relationships to other organs in men and women.
These can be present for many months, or even years, without causing any symptoms. The most common symptom is the passing of blood (or clots) in the water (haematuria) though sometimes there is pain when passing water (dysuria) or pains within the pelvis. Quite commonly nowadays an ultrasound scan suggests that there is a tumour in the bladder. In my experience this finding is only correct about half the time but the only way to know is to look inside.
The procedure is performed through a special telescope (resectoscope - see picture) with no external cuts.
The bladder is carefully examined both with the telescope and by feeling for any lumps on the outside. Any tumour that is seen (as shown in photo) is removed by cutting away small pieces using the resectoscope. Some of the underlying muscle is usually removed to make sure that the tumour has not spread into it. All the cut pieces are then washed out, any bleeding stopped and a catheter put inside to drain the bladder and any remaining blood.
The operation can be performed with either a full general anaesthetic or a spinal anaesthetic, where you are awake but temporarily have no feelings below your belly button. Please speak to the anaesthetist if you have any questions about the type of anaesthesia.
After the operation
There may be some big bags of fluid attached to the catheter for the first day or so. These help to wash out any blood clots. You will be encouraged to drink plenty of fluid, ideally about 3 litres for the first 24 hours, before returning to a more normal amount. Usually the catheter is removed after 1 or 2 days and you are kept in hospital until you are passing water well. There may be some stinging and some blood when you first pass water but this settles down fairly quickly.
Once at home there may still be occasional blood in the water and occasional pain when you pass water. If this happens drink a little more fluid to wash the bladder out. You do not generally have to see your own local doctor unless your problems are unbearable. If it becomes impossible to pass water please ring up or return to hospital. Heavy lifting, work and any driving should be avoided for the first few days following the operation and after that time can be gently reintroduced. It is important to remember that despite there being no external cuts this operation is classified as major surgery.
You will be reviewed in the clinic within a few weeks to discuss the results.
As with any operations there are a number of possible complications. Every effort is made to minimize the risk of these occurring and it is important to realise that the majority of patients do not suffer any long term problems related to the surgery.
There can be problems related to having an anaesthetic or being immobile for a period – these include chest infections and swelling of the legs, which rarely can be due to deep venous thrombosis (DVT). As such it is important that you try and get up and out of bed as soon as possible. You will also be given some special stockings which will help prevent DVT.
Bleeding. There is always some bleeding with this operation but it usually settles quickly and rarely causes trouble. A blood transfusion is rarely needed and very rarely it is necessary to return to the operating theatre to wash out some blood clots.
Urinary retention. Sometimes it is not possible to pass water after the catheter has been removed. There are all sorts of possible reasons for this but it usually settles after a further catheter has been inserted for a day or so. If there are continuing problems you may need further tests.
Bladder perforation. This is an extremely rare problem where a deep hole is made in the bladder. It is usually obvious at the time of the operation but sometimes only shows up later. The hole needs to be repaired and to do this requires a formal cutting operation (laparotomy). This means staying in hospital for up to another week.
Other organ injury. This is also a very rare problem. Sometimes the bladder can be stuck very close to other organs – bowel, uterus are the most common, and these organs can be damaged removing the tumour. If this does happen then they will probably need to be repaired, often with the help of other specialists at a cutting operation (laparotomy). You would end up being in hospital for at least another week.