Bladder tumours – Transurethral resection of bladder tumour (TURBT)

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We hope this patient information leaflet will support the information your surgeon has given you and help you to make an informed decision about having your bladder operation. You will have had a cystoscopy or other examination that has shown that you have an abnormal area (tumour) in your bladder. Your consultant will have recommended a transurethral resection of your bladder tumour(s) to investigate the type of tumour and treat any tumour(s) present.

What is a transurethral resection of a bladder tumour (TURBT)?
A transurethral resection of a bladder tumour or TURBT is a treatment for bladder tumours. The tumour or tumours are scraped away from inside the bladder and the chippings are sent to the path lab for examination. From this, your consultant will be able to find out whether the tumour cells are cancerous and, if they are, the grade and stage the cancer has reached. This information can then be used to help decide any future treatment needed.

Why do I need this procedure?
A TURBT is the standard treatment for bladder tumours. Benign bladder tumours usually grow very slowly. However, if they are not treated, they could become very large and cause problems by taking up too much space in your bladder or pressing on other organs in your body. Malignant tumours continue to grow unless they are removed. They can invade surrounding tissue and spread to other areas of the body causing further problems.

Usually two weeks before your operation date you will be asked to attend the hospital for a preoperative assessment. Your appointment should take approximately one hour.

What type of anaesthetic will I have?
The type of anaesthetic you will have will be decided by your anaesthetist who will speak to you before your operation. It will usually be a general anaesthetic where you are completely asleep, or a
regional/local anaesthetic given into your back which makes you numb from the waist down.

During the operation
Once the chippings have been removed, a one off instillation of Mitomycin-C will be instilled into the bladder for one hour post the surgery, unless contraindicated or at your consultants discretion. Mitomycin-C is a solution that can destroy cancer cells. It attacks cancerous cells when put in the bladder however, it does little damage to normal, healthy bladder lining. It is a chemotherapy drug, although because it is put straight in your bladder and not injected into your veins, you will not get the side effects people often associate with chemotherapy, such as hair loss, nausea and vomiting.

After the operation
Once the operation is over, you will be taken to the recovery room to allow the anaesthetic to wear off. It is in recovery where the mitomycin-c is drained by a Urology Nurse. A tube will be going into the bladder called a catheter. This will be attached to some irrigation fluid that continuously washes the bladder. This stops the blood clotting over the raw areas inside the bladder until it starts to heal. The Bladder irrigation and catheter remains in place until the urine is a light pink colour. It is important to drink plenty of fluids at this stage. Most importantly clear fluids or fruit squash. The Catheter is usually removed after 1-2 days, and providing you pass urine satisfactorily three times you will be allowed home.

On some occasions patients are unable to pass urine when the catheter is removed and have to be discharged with a catheter for a short period of time. Arrangements will be made prior to discharge for a community nurse to remove the catheter.

What are the risks?
Although serious complications are rare, every surgical procedure has risks. Your doctor or nurse will discuss the specific risks for this procedure with you in more detail before asking you to sign the consent form.

The risks of having a TURBT include:
• Blood in the urine – this is common (in more than one in 10 people) and you may experience a mild burning sensation when passing urine for a couple of days after your operation. You will be encouraged to drink plenty of water to keep hydrated and flush your system.
• Infection – this happens occasionally (in between one in 10 and one in 50 people). You will be given antibiotics to treat the infection if this occurs.
• Perforation of the bladder – this is rare (in less than one in 50 people) and will need a temporary urinary catheter or open surgical repair.
• Deep vein thrombosis (a blood clot, usually in the large leg veins). The stockings you are given will help to prevent this, and you may also have an injection – the doctors will assess you and discuss this with you if it is necessary.

When can I go back to my normal activities?
You will usually be able to go home about 48 hours after your procedure. We advise you:
• to speak to your doctor about how much time you will need off work after your operation. This will depend on your recovery and the type of work that you do. Usually you will need to take about two weeks off, but if your job involves lifting or heavy work, you may need to take three to four weeks off work.
• to start gentle exercises about a week after your surgery, but please do not do anything too energetic, such as playing contact sports, for a month.
• Not to drive again until you feel comfortable and are able to perform an emergency stop. Please check with your insurance provider before starting to drive again.

Your results
Your results should be available 2-3 Weeks after your operation. You case will be discussed in our urology MDT meeting which is held on a Monday and you will only receive an appointment after this had occurred. You will have an appointment in the follow-up clinic, where your doctor will be able to review your results and discuss your future care. Please make sure you have been given this appointment before you leave hospital after your operation.

The results from your TURBT will determine your future follow-up. Your doctor will discuss this with you when you come for your follow-up appointment. If you have bladder cancer and do not need any further invasive treatment, you will need to have regular cystoscopies to check the cancer has not returned. These will initially be at three-monthly intervals and then progressively less often if your bladder remains cancer-free. If you need further treatment or your tumour(s) return, your doctor will discuss this with you at your follow-up appointment.

Uro-Oncology Nursing Team is as follows:
Emelda Moos
Laura Miles
Alex Jones
Reena Kakodkar

Contact details; 01908 996901 (answerphone) Working hours: 8:30 – 16:00.

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