Monday, January 23, 2023

Transurethral Resection Of Bladder Tumor Procedure

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When Should I Seek Advice From My Physician

Transurethral Resection of the Prostate (TURP)

A patient should contact their physician if they run a 101 degree or greater fever or if they begin passing clots that are larger than 1 inch in diameter. Some will have cherry colored urine, but may also experience darker burgundy-colored urine and at times brown-colored urine. The color of urine typically is determined by how long a time has passed since the bleeding began. Drinking 48 ounces of water daily after TURBT can help avoid larger clots that may be problematic.

Patient Portal

Are There Side Effects To A Turbt

The most common side effects of the TURBT are bleeding, pain, and burning when urinating. These may be intermittent and can last for up to one month. If the bladder tumor is large, the urologist may choose to leave a catheter in the patients bladder for a day or two. This helps to minimize problems occurring from bleeding, clot formation in the bladder or expansion of the bladder due to possible storage of excess urine or blood. Even if the tumor is small, a catheter may be inserted to rinse the bladder out if the bleeding persists.

What Is Photodynamic Diagnosis

In some cases, PDD helps the surgeon to evaluate tumour cells which could have been undetected otherwise. This technique involves introducing a dye into the bladder an hour before the surgery. The dye is absorbed by cancer cells which makes these cancer cells glow red under a blue light during surgery.

PDD can also be used during follow-up cystoscopy. Your surgeon will decide whether this is necessary for you.

Recommended Reading: How To Fight A Bladder Infection Without Antibiotics

Results Of Transurethral Resection

Transurethral Resection will relieve symptoms very quickly. Men will experience a strong urine flow within a few days. You may be recommended for follow-up treatment to aid in easing symptoms. Transurethral Resection may or may not be the best treatment for your BPH. You will want to talk to your physician about what treatment will be best for you.

Urology Procedures

Tumours On The Lateral And Anterior Walls

Dr Tim Nathan Urology

Resection of lateral wall tumours may result in stimulation of ONR resulting in increased risk of perforation . Strategies that have been shown to reduce the likelihood of ONR would include avoidance of bladder overfilling, reduced cutting current, use of short intermittent burst current , use of bipolar electrocautery, and use of neuromuscular blockade .

Tumours on the anterior wall could be challenging to resect and may require suprapubic depression by an assistant as well as proper resectoscope angles. More effective resection might be achieved by using open-angled loops.

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A Cystoscopy Can Reveal Abnormal Cells

If a patient has symptoms and urine test results that suggest the presence of bladder cancer, then a healthcare provider will typically request a test called cystoscopy to examine the inside of the bladder for any signs of bladder cancer cells.1

If the cystoscopy reveals that there are areas of abnormal cells inside the bladder that might be cancer cells, then a biopsy needs to be used to examine the cells more closely. A biopsy involves taking a very small sample of tissue from the bladder to be analyzed in the laboratory. The TURBT procedure can be used to take the biopsy that is needed to make a definite diagnosis of bladder cancer.

What Are The Risks Of Bladder Tumor Biopsy And Resection

Bladder tumor biopsy and resection is a very safe procedure. However, like any surgery, it has some risks. These include:

  • Risks related to anesthesia.
  • Excessive or prolonged bleeding.
  • Perforation in the bladder.

If you have any symptoms such as fever, feeling cold and shivery, or heavy bleeding following bladder tumor biopsy and resection, you should seek medical help right away.

Read Also: Reasons For Frequent Bladder Infections

Turbt Recovery & Complications

After the procedure, a flexible tube may be inserted into the bladder through the urethra to assist with draining urine from the bladder. The catheter will usually stay in place for 1 to 3 days. For a few days after the catheter is removed, the patient may have difficulty controlling their urine. This should improve on its own.

Although no incision is made in the belly, TURBT is still considered a major surgery. To speed up recovery, the patient should plan on resting for a few days after the procedure. This includes avoiding stressful physical activities.

Overexertion can cause bleeding inside the bladder. Some blood in the urine, however, is normal. If this does not clear up after several days, or if urination continues to be difficult or blood clots are present in the urine, a physician should be contacted immediately. It is also normal to notice a couple of days of bloody urine again 10 to 14 days after surgery.

Antibiotics may be prescribed to prevent infections, including those of the urinary tract. If so, it is important to take them as directed in order to prevent a recurrent infection.

Other complications of TURBT are:

  • Perforation of the bladder wall

Sexual Effects Of Radical Cystectomy In Men

Bladder cancer treatment: TURBT

After surgery, many men have nerve damage that affects their ability to have erections. In some men this may improve over time. For the most part, the younger a man is, the more likely he is to regain the ability to have full erections. If this issue is important to you, discuss it with your doctor before surgery. Newer surgical techniques may help lower the chance of erection problems.

For more on sexual issues and ways to cope with them, see Sex and the Man With Cancer.

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En Bloc Resection Of Bladder Tumour Technique

Typically a circumferential incision is made on the mucosa around the tumour with the tip of laser fibre maintaining a distance of 5â10 mm from tumour edge. The dissection is carried out in the macroscopically normal mucosa and extended through the submucosal and muscular layer. The muscular fibres are divided cautiously from the periphery to the centre of the tumour. The lesion is then detached and removed using various exit strategies . Alternatively, ERBT may be performed by undermining the tumour base via antegrade application of short energy impulses. In general 30% of patients might not be suitable for EBRT due to tumour size and location. Although successful resection of tumour up to 7.5 cm has been reported , it is often avoided if tumour is greater than 3 cm in size or arises from anterior or posterior bladder wall .

This can be performed using various types of energy source: laser , Hybrid-Knife, electrode .

KTP laser has been shown to be effective using 30 W but due to its side fire property and its wider penetration of tissue fulguration compared to Ho:YAG or Tm:YAG laser it could be associated with a greater risk of damage out of sight. This would make Ho:YAG and Tm:YAG more suitable form of laser for this procedure. The Tm:YAG laser mostly uses 30â50 W and is the most adopted technology to date .

An overview of ERBT studies is shown in Table 5.

Table 5

How Do You Prepare For A Turbt

Normally, you have to stop eating and drinking the night before any procedure that requires anesthesia. Make sure your provider knows about all of the medications that you take, including over-the-counter medicines and supplements.

Your healthcare provider will tell you if you need to avoid taking any of your medication for instance, blood thinners and when you should stop. Dont just stop taking medication without discussing it with your provider.

If youre allowed to take medications in the morning before the TURBT, make sure you only take a sip or two of water.

Take a bath or shower before you go in for the procedure. Dont use any kind of lotions or perfumes or deodorants after your shower.

Dress comfortably the day of the procedure. Bring identification, but leave your money, credit cards and jewelry at home.

Bring someone who can drive you home. Between anesthesia and pain medication, it wont be safe for you to drive yourself.

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How Is Bladder Tumor Biopsy And Resection Performed

You may have general anesthesia for this procedure, which means youll be asleep for it. Some providers might use regional anesthesia, which means youll be awake. However, you wont feel any pain.

Bladder tumor biopsy and resection is performed when a doctor inserts a rigid instrument called a resectoscope into the bladder through the urethra. Inserting the resectoscope in this way means that no incisions are necessary.

Your provider will use the resectoscope to remove the tumor, which will be sent to a pathology lab for testing. Once the tumor is removed, your doctor will attempt to destroy any remaining cancer cells by burning the area using electric current by a process called fulguration or cauterization.

Your provider may decide to insert some type of chemotherapy medicine into the bladder using the scope. This is called intravesical chemotherapy. Your provider might suggest that you have maintenance intravesical chemotherapy for a period of time, meaning that you’ll have regular treatments.

What Happens During The Turbt Procedure

Transurethral Resection of Bladder Tumor: Procedure (Continued)

During TURBT, the urologist uses a resectoscopesimilar in shape to the cystoscope instrument used in the cystoscopy procedureto pass a tiny wire loop into the bladder through the urethra. The urethra is the hollow, tube-like organ that allows urine to flow out of the body from the bladder. The tiny wire loop can be used by the urologist to remove any tumors or areas of abnormal cells.

Tissues that are removed from the bladder are sent to the lab so that the cells can be analyzed. The base of the tumor, and any remaining cancer cells, may be treated with an electric current or laser to make sure the tumor has been treated completely. Based on the results of the biopsy, urologists may recommend any necessary follow-up treatments.

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Tumours At The Ureteral Orifices

Coagulation close to the ureteral orifices should be avoided as it may cause scarring and lead to ureteric obstruction . However, tumours that involve the ureteral orifices can be resected judiciously under pure cutting settings. This would be particularly beneficial as satisfactory renal function can be facilitated if cisplatin-based neoadjuvant chemotherapy is considered for MIBC. Although it may result in vesicoureteric reflux and would be uncommon to cause stricture, a temporary ureteric stent placement between 2 and 6 weeks can further reduce the risk. A form of imaging such as renal ultrasound, CT urogram or Diethylenetriamine Pentaacetic Acid renal scan after resection is recommended.

How You Have It

The surgeon puts a thin rigid tube called a cystoscope into your urethra.

The cystoscope has optic fibres inside it, a light, camera and eyepiece at one end. The surgeon can look through the eyepiece or see images on a TV screen.

The surgeon passes small instruments down the cystoscope to cut any tumours out of your bladder lining.

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Preoperative Details Of Turbt

Patients will undergo pre-anesthesia testing in order to evaluate physical condition and medical conditions. As antithrombotic therapy has become more prevalent, the decision whether to hold anticoagulants or antiplatelet agents is a commonly discussed topic. While there are no guidelines to follow regarding the perioperative management of these medications, it is an often-debated balance between adverse cardiovascular events and persistent perioperative hematuria. While low-dose aspirin can be continued in most cases, all other antiplatelet agents and anticoagulants are almost always held perioperatively, with the duration and plan for resumption made on a case-by-case basis.

Patients scheduled for anesthetic cystoscopy with TURBT must have sterile urine documented prior to instrumentation. Sterility is usually presumed on the basis of a microscopic urinalysis showing no bacteria or white blood cells . Patients with a positive urine culture are conventionally treated with a course of culture-specific antibiotics to achieve this desired sterility.

What Happens After The Surgery

Bladder Tumor Removal with TURBT – Urology Care Foundation

All the tumor specimens from the TURBT will be sent to a pathologist for review. The pathologist will confirm the type of bladder cancer and the depth of invasion into the bladder wall if any. This will help the pathologist and your medical team determine the stage and grade of your bladder cancer. These findings, along with results from imaging such as CT scans, will determine the type and duration of further treatment if necessary.

After TURBT surgery, you may recover at home or spend a few days in the hospital. It is possible that you might have a catheter inserted into your urethra to help prevent blockage. The catheter tube is removed when the bleeding from surgery has stopped.

It is common to feel the need to urinate frequently after surgery. It may even burn or sting when you use the bathroom. These symptoms should become better with time. To improve these symptoms, stay hydrated by drinking fluids, it will help the healing process. Do not be alarmed if your urine appears pink. This is normal because there may be blood in your urine. Contact your doctor if these symptoms last for more than a few weeks.

Strenuous activity and heavy lifting should be avoided for around three weeks after your surgery. This means you should not lift grocery bags, children, pets or other things that cause you to strain until your doctor tells you that it is okay to. Speak to your medical team about any other recommendations they suggest.

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I Had No Idea What To Expect

Going into this surgery I had no idea what to expect. It was very uncomfortable at some points to have the catheter in but I think this was because it may have been touching a tender spot in my bladder. Some people tell me they had no problem with it.

Following the TURBT, the normal procedure is to have chemo injected directly into your bladder for 6 weeks. The two medications used are BCG and Mitomycin. I, personally, am allergic to both so I cannot have any type of treatment to prevent recurrence so I have a cystoscopy every three months and a TURBT every three months.

Taking A Biopsy During A Turbt Procedure

When it is used to help diagnose bladder cancer, the TURBT procedure may involve taking small tissue samples from the area with abnormal cells or removing all of the tissue that contains abnormal cells. The urologist may also take samples from other parts of the bladder lining to check for cancer cells.

The biopsied tissue is then sent to the lab where it is analyzed to see if it contains cancer cells. Small samples of muscle from the walls of the bladder near the area of abnormal cells may also be taken for analysis, to see if it contains cancer cells that have grown into the muscle.

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Key Steps And Principles Of Turbt

After induction of anaesthesia patient is placed in the dorsal lithotomy position. The procedure can be performed either under spinal or general anaesthetics. General anaesthetics would be preferred if neuromuscular blockade is indicated to prevent stimulation of obturator nerve reflex during the resection of lateral wall tumours. Bimanual examination of the bladder under anaesthesia is performed before resection. The prostate should also be assessed for men. The TURBT is undertaken after a detailed pancystoscopic evaluation using both 30- and 70-degree lenses for optimal assessment of the urethra, prostate and bladder including the bladder neck. Alternatively, a retroflexion manoeuvre using a flexible cystoscope can also be utilized. The anterior wall and the dome of the bladder might require suprapubic pressure for better visualisation.

How To Prepare For Transurethral Resection

Transurethral Needle Electrode Resection of Bladder Tumor: A Technique ...

Before your surgery, your physician will ask that you end your medications that are used as blood-thinners. You will likely be given an antibiotic to prevent a urinary tract infection after the surgery. Typically, you are able to go home after the surgery, so you will need someone to drive you home. You should not work or do any strenuous activity for up to six weeks after the surgery. Your physician will be able to give you a better expectation of how much recovery time you will need.

The procedure will take between sixty to ninety minutes. You will be given general anesthesia. This means that you will be asleep for the duration of the surgery. If your physician recommends a spinal anesthesia, then you will be awake but not feel anything.

You are likely to stay in the hospital for one or two days. You will have a catheter because the swelling will block the urine flow. This will be removed within 48 hours. You may notice blood in the urine or irritating urinary symptoms. It is normal to see blood right after the surgery. If the blood becomes thick or begins to worsen, then you will want to speak to your physician. Blood clots can block the flow of urine. Painful urination will improve within eight weeks.

After surgery, your physician will likely recommend the following:

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Preoperative Considerations History And Physical

As with any operation, the treatment begins in the outpatient setting. At this time, a full history is obtained, and a focused urological physical examination is performed. The history should include the patients age, sex, past medical history, smoking history, history of bladder cancer or other malignancies, previous surgical history including endoscopic treatment and any intravesical therapy following the diagnosis of bladder cancer . A review of the patients imaging studies is important to determine the status of the upper urinary tract.

On the day of the operation, the history and physical exam should be reviewed. The case should be discussed with the anesthesiologist. The type of anesthesia is important. The patient should be fully relaxed so that the bladder can be filled to the desired amount . General anesthesia with complete neuromuscular blockade is often preferred, as it allows the patient to be paralyzed as needed intraoperatively and to recover quickly postoperatively. Spinal anesthesia is also a reasonable option as it ensures the patient will not move during the procedure and maximizes bladder relaxation. Although we have never used this technique, transvesical injection of the obturator nerve has been reported to be an effective method to block the adductor or obturator reflex. Lastly, in addition to the routine preoperative lab values, the team should review any history of anticoagulant therapy, which is common in elderly patients.

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