Most people with suspected bladder cancer have a type of surgery called transurethral resection of bladder tumour (TURBT). The TURBT is done under a general or spinal anaesthetic. It takes 15–40 minutes, and does not involve any external cuts to the body. A slender hollow tube with a light and a camera, known as a cystoscope, is passed through the urethra and into the bladder. The surgeon may use a wire loop on the cystoscope to “shave” and remove the tumour through the urethra. Other methods for destroying the cancer cells include burning the base of the tumour with the cystoscope (fulguration), or using a high-energy laser.
Most people who have TURBT surgery need to stay in hospital for 1–2 days. Despite not having any skin incisions the area around the internal bladder incisions are raw and covered with scabs to promote healing and prevent bleeding. Certain precautions are required to ensure that these scabs are not disturbed over the next 2-4 weeks as the bladder heals.
WHAT CAN I EXPECT AFTER THE PROCEDURE?
- At the end of the operation, a thin tube (catheter) may be inserted into your bladder, which drains urine into a bag. The catheter is connected to a system that washes the blood and blood clots out of your bladder. This is known as bladder irrigation. When there is no longer a risk of clots, usually after 1-2 days, the catheter will be removed and you will be able to go home if you are passing adequate amounts of urine. If the tumour is small, you may not need a catheter and be discharged the same day.
- Bladder spasms – due to the catheter. Sometimes medications are required if these are severe.
- Burning when you pass urine is common and can last up to a week. You can take Ural sachets to help with this.
- Bleeding – this usually reduces over time, but can be intermittent and should stop after 4-6 weeks. You should increase your oral fluid intake to at least two to three litres of fluid per day (unless you have any medical reason not to do so) and you can back off on your fluid intake if your urine is clear.
- Other urinary symptoms (eg. frequency, urgency) can last for 2-4 weeks
WHAT ABOUT DIET?
- Drink plenty of fluids (8-10 glasses or 2-3 litres, unless you are on a fluid restriction due to a heart condition)
- Avoid acidic drinks such as orange or cranberry juice which may increase burning, stinging and irritate the bladder
- Eat a diet high in fibre to prevent the need for straining when using your bowels
WHAT ABOUT EXERCISE/ACTIVITY?
- Avoid for 2 weeks after surgery unless otherwise instructed by your doctor:
- strenuous activity
- heavy lifting (eg. grocery shopping, picking up children)
- sexual activity
- engage in sports
- Avoid driving a car for 1-2 weeks
- There is no restriction on walking
WHAT ABOUT MEDICATIONS?
- You can resume your usual medications
- If your blood thinning medication was stopped, your Doctor will let you know when to recommence
- You can take 1-2 paracetamol every 4-6 hours for pain and discomfort (no more than 8 in a day)
- Ural sachets (urine alkaliser) available from chemists and supermarkets, reduce acidity of the urine and provide relief from symptoms such as burning and stinging
WHAT ARE THE POSSIBLE COMPLICATIONS?
- Significant bleeding, possibly with clots – this may occur up to 6 weeks after the procedure and usually a result of the scab coming away during the healing process. It is usually possible to flush the blood through by increasing your oral intake
- Urinary retention (unable to pass urine) – if this happens you must go to the Emergency department
- Urinary infection – burning/pain during urination, fever, chills
- Urethral strictures – when scarring occurs in and around the water pipe, it can cause blockage to the urine flow. Strictures may need to be dilated or need further surgery.
NOTIFY GEELONG UROLOGY or your GP if you experience any of the following:
- Heavy bleeding – urine that looks like pure blood
- Increased discomfort, severe pain and burning when passing urine
- Cloudy or offensive urine
- Fever (temperature over 37.5 degrees), chills, shakes or feeling generally unwell
- Increasing difficulty or unable to pass urine
FOLLOW UP APPOINTMENT
Your doctor will generally speak to about the results of the procedure before you are discharged home and an appointment for your follow-up will be organised in around 2 weeks to discuss the pathology results. If an appointment time is not given to you on discharge from hospital, you will need to phone Geelong Urology to make an appointment.
If you have any queries please contact Geelong Urology on 03 5229 9105 during business hours OR leave a message on the After Hours Urology Paging Service 03 9387 1000