Day case TURBT (Transurethral Resection of the Bladder Tumour)

You have had a cystoscopy (where a special telescope is passed into your bladder), an ultrasound scan, or an X-ray which shows that you have a tumour in your bladder.

Bladder cancers grow and look like warts or mushrooms on the lining of the bladder. As they develop, they can put down deeper roots into the muscle wall of the bladder (this is called a muscle invasive tumour). Most bladder cancers are small. They are called superficial (or non-muscle invasive) bladder cancers and are confined to the inner lining of the bladder only.

Benefits 

By removing the tumour, we can analyse the samples under a microscope to find out more about whether your condition is cancerous, assess what type of cancer this is and how far it has gone into the bladder wall. This information will help us plan any further treatment you may need.

Risks

Common (almost all patients will experience):

• Need for a period of catheterisation (a catheter is a tube placed into the bladder, to drain your urine) post-operatively.
• Mild burning or bleeding for a short time after the operation. It is normal for this to happen after your operation and will ease over 10-14 days.

Less common (between 1 in 10 and 1 in 50) patients will experience:

• Infection of your bladder requiring antibiotic treatment.
• Recurrence of the tumour (it grows back after removal) and/or incomplete removal.

Rarely (between 1 in 50 and 1 in 250) patients will experience:

• Delayed or ongoing bleeding requiring further surgery or readmission to hospital.
• Damage to the ureters (pipes draining your kidneys).
• Injury to your urethra (waterpipe) causing delayed scarring and a stricture (narrowing).
• Perforation (a hole) in your bladder requiring a catheter for a prolonged period or open surgical repair.
• Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus (lung clot), deep vein thrombosis (leg clot), heart attack and death). Your anaesthetist can estimate your individual risk.

The surgeon will discuss with you how likely any of these are and how they are treated, before your operation.

What are the risks of a general anaesthetic?

Straight afterwards you may feel tired, dizzy, or weak. You must have someone to collect you and stay with you for the first 24 hours. 

During the first 24 hours you should not:

• Drive or operate any motorised vehicle or electrical equipment.
• Sign any legal documents or make important decisions.
• Drink alcohol.

You may feel weak or dizzy at times during the first 7 – 10 days. If this happens, sit down until the feeling passes. 

You may also have the ‘post-operative blues’ and feel a little depressed. If any of these symptoms do not go away, please contact your GP for help and advice.

Removing the tumour is the only reliable way to find out what type of tumour you have. If you do not have the operation and the tumour is a superficial (non muscle invasive) bladder cancer (just on the surface of your bladder), there is a risk that it will change into an invasive cancer or grow bigger if not removed.

If the tumour is a muscle invasive bladder cancer and it is not removed, there is a risk that it will grow deeper into the tissues of your bladder and the cancer may spread to other parts of your body, which could affect your lifespan. In some cases, chemotherapy, immunotherapy, radiotherapy, or cystectomy may be alternative options.

Chemotherapy or immunotherapy – where medicines are instilled into your bladder (for early cancer) or given intravenously (for more advanced cancer). This is not usually performed without samples having been taken from the bladder.

Radiotherapy – where radio waves are aimed at your bladder (usually for more advanced cancers). This is not usually done without samples having been taken from the bladder.

Cystectomy – a major operation to remove the bladder, this is usually an option for more advanced tumours and is not usually done without samples being taken from the bladder first.

If you cannot have a general or spinal anaesthetic, there is an option to perform this operation under a local anaesthetic with a laser (Trans Urethral Laser Ablation – TULA), however, this is not the preferred option, as we do not get as much information about your cancer. TULA is therefore only offered in specific circumstances such as if you are very high risk for complications from a general or spinal anaesthetic.

A request form is completed by the doctor you see in clinic and sent to the waiting list team. 

The request is then processed and a date for pre-op assessment (if you do not have it on the same day as your outpatient appointment) and surgery will be sent to you through the post or by phone. 

Pre-op assessment clinic

At your pre-op assessment, a nurse will take your medical history, explain the type of anaesthetic you will have (usually a general anaesthetic), and what to expect after surgery. They will also answer any questions you may have. 

Please bring details of any medication you are taking or the medicines themselves. Also let the nurse know if you are allergic to any medicines, tablets, or plasters. 

You will have some screening tests. These may include checking. your blood pressure, taking a blood sample or having an electrocardiogram (ECG) to check your heart. 

The nurse will confirm that you are medically fit for your operation as a day case procedure, or if not fit and able for a day case, they explain about staying in hospital overnight. Day case is the standard at North Bristol NHS Trust.

The letter from the hospital will provide full details, but it usually asks you to report to Medirooms, Gate 21, Level 3, Brunel Building, Southmead Hospital.

If you have been given a consent form, please bring it with you. 

What happens during the operation?

• We will usually give you a general anaesthetic (where you are put to sleep) but may also carry out the procedure under spinal anaesthetic (where you have an injection in your back to numb you from the waist downwards).
• Once you are anaesthetised, you will usually have an injection of antibiotics to try to prevent any infections afterwards.
• Your surgeon will then put a telescopic instrument called a cystoscope into your urethra (the tube through which you pass urine) and up into your bladder. The cystoscope is about the thickness of a pencil or a pen and has a tiny video camera on one end, so your surgeon can view an image of your urinary system on a television screen. If your urethra is too narrow, they will gently insert small instruments called dilators to gradually widen the opening.
• Your surgeon will inject sterile salt water (saline) through the cystoscope to help expand your bladder and allow them to get a clear view of the tumour. They will pass small instruments through the cystoscope to collect a tissue sample (biopsy) from inside your bladder. This sample will be sent to the laboratory to be examined.
• Your surgeon will then cut away either part, or all of the tumour. The tumour will be sent to the laboratory for further tests and analysis. Because we do not need to make any cuts on the outside of your body during this procedure, you will not have any visible wounds or stitches.

How long does the operation take? 

The procedure takes about 45 minutes to 1 hour and 15 minutes, depending on the size of your tumour and where it is.

As you had a general or spinal anaesthetic you will go to the recovery area in the theatre department for at least four hours because you will feel drowsy and need time to recover (general) or your legs will still be numb for a few hours (spinal).

You will need a relative, friend, or carer who can escort you home and stay with you for the first 24 hours after your procedure. Please let them know they may have to wait for you if you are not ready to leave.

You may have a urinary catheter left in your bladder after your operation. This is a flexible tube that drains your urine into a bag outside your body. The catheter may also be used to flush out your bladder and wash away any blood clots after surgery (called irrigation). This means you will have a bag of salt solution connected to the catheter which will flow into your bladder. This irrigation will be stopped once your urine runs clear.

The other reason for having a catheter in after this procedure is that you may be offered a dose of intravesical chemotherapy (Mitomycin C) after the operation – Mitomycin C is put into the bladder for an hour using your catheter. This has been proven to help prevent tumours from growing back. Occasionally there may be reasons why this is not suitable, and your surgeon will discuss this with you before the operation.

You may need to have the catheter in anywhere from 2-10 days, depending on what happens during the operation. For most people, this is 2-5 days. Before you leave hospital, you will be given a date to return to hospital for the removal of your catheter (Trial Without Catheter – TWOC). Our nurses will explain how to care for the catheter, and when and where to return to have it removed.

Sometimes we are able to put you on a pathway where you are able to remove the catheter yourself at home (self TWOC). If you are suitable for this, you will be given details of this after the operation.

In most situations, this will be day case surgery and you will be able to go home on the same day, once you have fully recovered. 

Please ask your surgical team for a fit note (sick note) if required.

You may want to go to the loo more often for a while after the catheter has been removed. You may also find it quite sore or painful the first few times that you pass urine. This is normal. It may take several weeks for these symptoms to settle. 

You may pass some blood or small clots in your urine for 10-14 days after your operation. This is normal. Drink plenty of fluids (not alcoholic) to help wash away the blood and ease any soreness. 

We advise you to:

• Speak to your doctor about how much time you will need off work after your operation. This will depend on how quickly you recover and the type of work you do. You usually need to take about 2 weeks off. If your job involves lifting or heavy work, you may need to be away from work for 3-4 weeks.
• Start gentle exercises about a week after your surgery. Please do not do anything too energetic for 1 month, such as playing contact sports like rugby.
• Avoid driving until you feel comfortable and can do an emergency stop. Please check with your insurance provider before starting to drive again.

We may give you antibiotics to prevent you from developing an infection after your operation. Please make sure you take the whole course.

If samples were sent away as part of the procedure, you will be informed of the results 2-3 weeks after the surgery, usually by an appointment with one of our Cancer Nurse Specialists. 

If you have a catheter, we will arrange an appointment for you to have it removed, anytime from 2-10 days after the procedure. This appointment is usually at Urology Outpatients, Gate 36, Level 1, pink zone, in the Brunel Building, Southmead Hospital.

Please do not bring in valuables, jewellery or large sums of money. If this is unavoidable, please ask a relative to take them home for you. The hospital cannot accept liability for the loss of personal items.

For general queries or concerns after your operation, please contact the hospital on: 

Gate 36 (Urology Outpatients): 0117 414 0740 

Urology Cancer Nurse Specialists: 0117 414 0512