Bladder Tumour

Transurethral Telescopic Resection of a Bladder Tumor

Key Points

A bladder tumor is one of the commonest causes of hematuria (blood in your urine)
Bladder tumors are resected (shaved) off the bladder wall using a telescope put into your bladder through your urethra (waterpipe)
The removed fragments of tissue are sent for pathology analysis to see whether the tumor is cancerous, and to assess how deeply the tumor has grown into the wall of your bladder
Some patients may need additional treatment (with chemotherapy, radiotherapy, or further surgery)
Most patients need periodic follow-ups with further telescopic bladder examinations

What Does This Procedure Involve?

Removal of a bladder tumor (growth) from your bladder using diathermy (electrical current) or laser energy, through a telescope passed into your bladder along your urethra (waterpipe).

What Are the Alternatives?

Radiotherapy – external beam radiotherapy given as a series of treatments to your bladder may be appropriate for some tumors
Chemotherapy – using drugs instilled into the bladder (for early bladder cancer) or given intravenously (for more advanced cancer)
Surgical removal of your bladder – using open, laparoscopic (keyhole) or robotic-assisted techniques may be an option for more advanced tumors

What Happens on the Day of the Procedure?

Your urologist (or a member of their team) will briefly review your history and medications and will discuss the surgery again with you to confirm your consent.

An anesthetist will see you, to discuss the options of a general anesthetic or spinal anesthetic. The anesthetist will also discuss pain relief after the procedure with you.

We may provide you with a pair of TED stockings to wear, and we may give you a Heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.

Details of the Procedure

We carry out the procedure either under a general anesthetic (where you will be asleep) or under a spinal anesthetic (where you will feel nothing from your waist down)
We usually give you an injection of antibiotics before the procedure, after you have been checked for any allergies
We put a telescope through your urethra (waterpipe) into the bladder to see the tumor (pictured)
Using diathermy (electric current) or laser energy, we resect (shave) the tumor of the bladder wall, piece by piece
We stop any bleeding by cauterizing the tumor base with diathermy or a laser
We remove the fragments from your bladder using suction and send them for pathology analysis
We normally put a bladder catheter through your urethra with irrigation to prevent any blood clots from forming
We use the catheter to instill a Mitomycin C (an anti-cancer drug) into your bladder immediately after the procedure; this is left in your bladder for one hour and then drained away
The procedure takes between 15 minutes and 90 minutes to perform, depending on the size and number of tumors in your bladder
You can expect to stay in the hospital for one to three days.

Are There Any After-Effects?

The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed exceedingly rare after-effects (occurring in less than 1 in 250 patients) individually.

The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual: can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual.

What Is My Risk of a Hospital-Acquired Infection?

Your risk of getting an infection in the hospital is approximately 8 in 100 (8%); this includes getting MRSA or a Clostridium diffcile bowel infection. This figure is higher if you are in a “high-risk” group of patients, such as patients who have had:

What Happens on the Day of the Procedure?

Long-term drainage tubes (e.g., Catheters)
Bladder removal
Long hospital stays
Multiple hospital admissions

What Can I Expect When I Get Home?

You will get some bleeding and blood clots in your urine which can last several days
You may find passing urine uncomfortable at first; simple painkillers such as paracetamol will help with this
You will tend to feel tired and “washed out”
You may get some discharge of blood from your urethra, especially if it was necessary to “stretch” your urethra to insert the telescope
You may get further bleeding up to three weeks after the initial blood loss has stopped; this is known as secondary hemorrhage and is often due to infection in your bladder
If the bleeding stops you from passing urine, you should contact your GP or urologist immediately, or go to your local A&E Department
You will be advised about your recovery at home
You will be given a copy of your discharge summary
Any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy
The fragments of bladder tumor will be examined under a microscope and the results discussed in a multi-disciplinary team (MDT) meeting
We will inform you of the result and will arrange to review you to discuss whether further treatment is needed

Is There Anyway I Can Prevent Post-Operative Problems?

Yes, several measures will help:

Drink plenty of fluid – you should aim to drink at least two liters daily for the first two or three days. This will dilute your urine and reduce any discomfort when you pass urine. It also helps to keep the bladder flushed, so that blood clots are less likely to develop and the urine continues to flow easily.
Take paracetamol – unless there is a medical reason why you should not). For the first 24 to 48 hours, this will help to make passing urine more comfortable
Take your antibiotics – if you have been given a course of antibiotics to take home with you, you must complete the course
Try to stay active – resuming normal activities as soon as you feel able will speed your recovery. You may find you need slightly more sleep than usual for the first few days after your discharge
Watch out for urine infection – even if there is blood in your urine, it is unlikely that any discomfort in passing urine is due to infection. If you develop a fever (over 37.5°C), or if your urine becomes cloudy and thick, you could have an infection. You should contact your GP so that he/she can decide whether you need antibiotics. If you find it very painful to pass clots or cannot pass urine at all, you should contact your GP straight away. If you are unable to contact your GP, telephone your urology specialist nurse (during office hours) or the urology ward of your local hospital (outside normal working hours).

General Information About Surgical Procedures Before your Procedure

Please tell a member of the medical team if you have:

An implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft)
A regular prescription for a blood-thinning agent (warfarin, aspirin, clopidogrel, rivaroxaban, or dabigatran)
A present or previous MRSA infection
A high risk of variant-CJD (e.g., if you have had a corneal transplant, a neurosurgical dural transplant, or human growth hormone treatment)

Before You Go Home

We will tell you how the procedure went, and you should:

Make sure you understand what has been done
Ask the surgeon if everything went as planned
Let the staff know if you have any discomfort
Ask what you can (and cannot) do at home
Make sure you know what happens next
Ask when you can return to normal activities

We will give you advice about what to look out for when you get home. Your surgeon or nurse will also give you details of who to contact, and how to contact them, in the event of problems.

Smoking and Surgery

Ideally, we would prefer you to stop smoking before any procedure. Smoking can cause cancers of the urinary tract, encourage existing cancers to recur or progress, and increase the risk of complications after surgery. We strongly advise anyone with bladder cancer to stop smoking.