Introduction
Transurethral resection of bladder tumour (TURBT) is a procedure performed to remove a bladder tumour. This is often performed when a bladder mass is seen on a scan (ultrasound or CT scan) or when a bladder tumour is seen at the time of a cystoscopy. The aim of this procedure is to remove as much visible tumour as possible and gain enough tissue that the pathologist can make an accurate diagnosis about the type of tumour, its grade (how aggressive the tumour is) and stage (how advanced through the layers of the bladder wall the tumour is).
Preoperative Instructions
A urine test will be performed to ensure the patient does not have an active urinary tract infection, as this will require treatment prior to the procedure. Certain medications that promote bleeding such as warfarin, clopidogrel, rivaroxaban and apixaban will need to be stopped for certain period prior to the procedure to reduce the risk of significant bleeding. This procedure can still be performed if the patient is taking aspirin.
Procedure
Initially a cystoscopy is performed to assess the lower urinary tract and to identify the location and size of the tumour. A resectoscope is then placed which is the instrument that is used to resect the bladder tumour. Once the tissue has been resected and removed, any bleeding is controlled and a catheter is placed in the bladder. This catheter allows for irrigating fluid to run into the bladder to wash out any clots and further reduce the risk of bleeding.
Postoperative Instructions
The patient will awaken with a catheter in and irrigating solution running into the bladder. Irrigation of the bladder usually stops in the first 6-8 hours and the catheter is removed in 24 hours. At this point the patient undergoes a trial of void where they are observed to ensure they can empty their bladder appropriately. The patient is then discharged home with a review in approximately 2 weeks to obtain the pathology results of the tissue that was resected. During this time the patient may notice urinary frequency, urgency, dysuria and may also notice some blood in the urine. These symptoms all gradually settle down in the first few weeks after the procedure.
Risks
Some of the risks associated with a TURBT are:
- Bleeding.
- Infection.
- Bladder perforation.
- Urethral stricture.
Follow up treatment
The histology results will dictate what further treatment may be required. If the bladder tumour is completely resected at the first operation, the patient will undergo ongoing surveillance with repeat cystoscopies to determine if the tumour has recurred or if new tumours have appeared. If the initial tumour is more advanced and or of a particularly aggressive variant, further treatment will be required and this will be discussed with you by your surgeon.