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Bladder tumours

This page will provide you with information about the transurethral resection of bladder tumour (TURBT) procedure used to treat bladder tumours. For further details, you should speak to your consultant.

What are bladder tumours?

Bladder tumours are a form of cancerous growth that begins in the bladder lining. They can bleed, resulting in your urine containing blood (haematuria), and can also cause blood clots to develop. This leads to your bladder being unable to empty efficiently. Other symptoms of the condition are feeling a burning sensation when passing urine, and feeling the need to pass urine more frequently. In the event that your surgeon recommends a trans-urethral resection of a bladder tumour (or TURBT), the final decision is yours as to whether you wish to go ahead with the procedure. The next few paragraphs will inform you about the benefits and risks associated with the operation, and therefore enable you make an informed choice. However, if you have questions that are not addressed in this paper, check with the surgeon or your healthcare team.

Types of bladder tumour— non-invasive and invasive

A non-invasive tumour mainly remains within the bladder lining. It is the most common type of bladder cancer. There is a risk of the development of an invasive tumour (between 10 and 15 in 100). Invasive tumours are cancers that grow into and through the wall of the bladder. The cancer can also spread to other areas of the body. The tissue removed by the surgeon during the procedure is examined under a microscope to determine the tumour type. You might have just the one, but there is also a chance there may be  a number of them. The surgeon can also perform a biopsy (the removal of small pieces of tissue) on the parts of your bladder that appear to be unaffected. From these they can tell if the cells that make up the bladder lining are becoming unstable, and therefore have an increased likelihood of forming tumours (carcinoma in situ).

What are the benefits?

The result of surgery is that the symptoms should get better. By resecting (or scraping away) a non-invasive bladder tumour, not only should it should remove the tumour, but there will be a reduced risk of the development of an invasive cancer. If the cancer is invasive, a TURBT will not get rid of the cancer entirely. The surgeon should be able to recommend the best type of treatment for your case after examining the tissue under a microscope.

What are the alternatives?

When it comes to detecting what form of cancer you have, a resection of the tumour is the only dependable way of doing so.

Deciding against the operation

With a cancerous tumour, the risk will be that it will grow deeper into the tissue of the bladder and the cancer might spread to other areas of your body.

In the case of a superficial tumour, the risk will be that it will turn into a cancerous one.

During the operation

Initially the healthcare team will run a number of checks, to make sure that the operation is the same procedure you came in to have. By confirming your name and the procedure you are having, you will help them to carry out these checks quickly. The operation should take less that 30 minutes, and takes place under a general or spinal anaesthetic. The anaesthetist will discuss your options and recommend the best type of anaesthetic for you. Antibiotics may also be administered during the procedure, to reduce the risk of infection. First the surgeon passes a small operating telescope (resectoscope) into the bladder through the the tube that transports the urine from the bladder (the urethra). The resectoscope is used to search for and then resect any tumours within the bladder (see figure 1). 

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By doing this, raw areas are sealed with an electric current (known as cauterisation). The surgeon may use the resectosope to carry out biopsies, to determine if you have carcinoma in situ. Having completed the operation, the surgeon removes the resectoscope and often places a catheter (tube) into the bladder. The benefits of doing this are as follows:

  1. To prevent any blood clots, as the catheter enables the bladder can be washed out with fluid.
  2. The catheter will enable you to pass urine easily

Other potential forms of treatment

It may be that your surgeon recommends a single dose of chemotherapy, that is administered straight into the bladder via the catheter. This is known as intravesical chemotherapy, and given this way, the chemotherapy can reduce the risk of any new growths developing in the bladder lining. The surgeon may recommend this even if you may not have an invasive cancer.

If I’m already taking medication

You doctor should know about any medication you are taking before the operation. This medication can be:

  1. Herbal/ complementary remedies
  2. Any form of blood-thinning medication
  3. Dietary supplements
  4. Over-the-counter medication

For the operation to be successful:

  • If possible, try to maintain a healthy weight, as you increase your risk of developing complications when you are overweight.
  • Exercising regularly will aid preparation for the procedure, as well as recovery from it. Check with your GP before undertaking an exercise regime.
  • If you smoke, stop smoking immediately. This is a main contribution to the development of this type of cancer. By stopping now you reduce the potential for new bladder tumours developing. By quitting smoking several weeks before the procedure, you will help to reduce the risk of developing complications, as well as improving your overall health in the future.

Are there complications that can occur?

Whilst the healthcare team will do everything they can to make sure that the operation is carried out as safely as possible, there is a risk of complications occurring.  Some of these are serious, and may possibly be fatal. If there is anything you are unsure of or do not understand, you should consult your doctor. The following figures relating to risk are taken from studies of people who have already had this procedure. Your doctor may be able to tell you if your risk of developing complications is higher or lower than the norm.

  1. Anaesthesia

The anaesthetist should be able to discuss any potential complications.

2. General

  • Mild pain. This is controlled with painkillers, for example paracetamol.
  • Infection. There is a 1 in 30 risk of this. Infection symptoms will include needing to pass urine frequently, as well as passing small amounts with discomfort. If these continue to get worse, contact your GP, as you may require antibiotics to treat the infection.
  • Deep-vein thrombosis (DVT).  This is also known as a blood clot in the leg, and causes pain, redness/ swelling in the leg, or the veins beneath the surface of the skin to seem bigger than normal. The risk will be assessed by the healthcare team, usually they will request that you get out of bed as soon as possible following the operation. They may also provide you with medications, special stockings or injections in order to manage the problem. If you suspect you may have DVT, it is vital you let the healthcare team know straight away.
  • Pulmonary embolus (blood clot in the lung). Symptoms of this are: shortness of breath, coughing up blood or pain in the upper back or chest. You must tell the healthcare team immediately if you have any of these symptoms. If you are at home when these happen, request an ambulance or go to your nearest Emergency department as soon as possible.
  • Bleeding occurring during or after the operation. Most people notice blood in their urine, and any bleeding that happens is often in little amounts. The healthcare team can perform a bladder washout, by passing water through the catheter and into the bladder, in order to remove any blood clots and to wash out any blood. In the case of heavier bleeding, it may be that you need a blood transfusion (1 in 50 risk), and very rarely, you may need another operation.

3. Specific

  • Making a hole in the bladder— 1 in 50. Risk is higher if the surgeon has to remove a tumour by scraping away the bladder wall. If the catheter drains well, it should only take a few days for the hole to heal. If it does not, it may require surgery.
  • Narrowing of the urethra (stricture)— this is caused by the formation of scar tissue. It could require another operation (less than 1 in 200).

Recovery

At the hospital

Once the operation has ended, you will get transferred first to the recovery area, and then back to your room. After one to two days the catheter is removed, and you should be able to go home once you have passed urine. It might be be that your consultant recommends that you remain in hospital a little while longer. The healthcare team are available to treat any complications, or for reassurance, either at home or in the hospital. If you have any worries at all, do not hesitate to contact them.

At home

Make sure you follow the instructions given to you by the healthcare team carefully. By doing so, you will reduce the risk of a blood clot. This may mean that you are required to wear special stockings, or need to take medication. It could be that you will encounter a stinging sensation the first couple of times that you pass urine. Ensure that you drink plenty of water, as not only will it be easier to pass urine, but you also reduce the risk of blood clots. You should be able to go back to work after two weeks. In the first week, try not to do any strenuous exercise, although regular exercise is recommended in order to recover as soon as possible. Before beginning an exercise regime, check with your consultant. Do not drive, unless you are confident that you have complete control over your vehicle. It is vital to check this with your consultant. Check your insurance policy to make sure it covers you after the procedure has taken place.It is not unusual to experience blood in the urine whilst any raw areas are healing in the the bladder. If the bladder gets full and painful, make sure to contact your conulstant, as it may be that you have a blood clot. If this is the case, you might be required to return to hospital to remove it using a catheter.

In future

The operation results will be discussed with you by the healthcare team, although it could be that you are required to return to the clinic for your biopsy, as these will not be available for a few days.Should you have an invasive tumour, the treatment options will be discussed with you by your surgeon.If you have carcinoma in situ, the surgeon may recommend a course of intravesical chemotherapy. This should help reduce the risk of any new tumours developing.Should you have a non-invasive tumour, you will be required to have regular cystoscopies (from 1-6 weeks to annually), to see if any new tumours have developed.

Summary

Bladder tumours can cause serious problem if not treated. A TURBT should alleviate the symptoms and will enable your doctor to discuss the best forms of treatment with you.Whilst surgery is usually very safe and effective, it is important to note that complications can occur. You should know about these, so that you can make an informed choice about having the procedure. If you are aware of them, it will aid early detection and treatment of any potential problems.Retain this information document, in case you need to discuss any of its contents with your consultant.

 

References: EIDO Healthcare Limited – The operation and treatment information on this page is produced using information from EIDO Healthcare Ltd and is licensed by Aspen Healthcare. 

The information should not replace advice that your relevant health professional would give you.

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