Trans urethral resection of bladder tumour

You have been informed that you have a bladder tumour, and we are suspicious that this is a bladder cancer. We have written this leaflet to answer some of your questions that you may have about this common condition.

In the case of bladder cancer there are two types of malignant tumours (cancerous): invasive and non-invasive.

The most common is a non invasive bladder cancer which occurs in 70 - 75% of bladder cancers. The remaining 25 - 30% are invasive bladder cancers.

The bladder is a hollow, muscular, balloon-like organ that collects and stores urine. The two kidneys, towards the back under the ribs, produce urine that is carried to the bladder by tubes called ureters. The bladder then stores the urine until it is full enough to empty it through a tube called the urethra. In women the urethra is a very short tube immediately in front of the vagina (birth canal).

In men the tube is longer and passes through the prostate gland and penis.

The tumours in non invasive bladder cancer look like tiny frilly mushrooms, with their stems attached to the inner lining of the bladder.

They are cancers confined to the inner lining of the bladder and do not extend into the muscle wall, They may develop as a single tumour, or there may be many; they may be small (only a few millimetres across) or large (up to several centimetres).

The tumour needs to be removed and analysed under a microscope.

In order to remove bladder tumours it is usual to be given a general or spinal anaesthetic. The surgeon then uses a resectoscope, which is a thin tube fitted with a telescope through which removal of tissue is possible. The surgeon can often tell by looking at the tumours whether they are invasive or non-invasive, but samples are always sent to the laboratory for examination under the microscope.

This gives the surgeon further information about the type of tumour, and whether it extends into the bladder wall.

Surgery

Non invasive bladder cancer only affects the lining of the bladder, and the tumours can usually be removed very easily using a resectoscope. This is called a TURBT (Transurethral Resection of the Bladder Tumour).

This is usually performed under a general or spinal anaesthetic. More information about this is available at your pre-op assessment.

The TURBT is carried out by passing a small camera through your urethra into the bladder. There will be no open wounds. The tumour is shaved off the bladder wall and the area is cauterized (sealed) using electrical current to prevent excessive bleeding. In this way several tumours can be treated at the same time. The tumour is then sent to be analysed in the pathology department. (looked at under a microscope). The results should be available in approximately two – three weeks.

Often you are given a treatment straight into the bladder following surgery.

A small amount of fluid containing a special chemotherapy drug called Mitomycin C, helps to prevent these tumours recurring, this is put into the bladder via a catheter. (More information is available in the booklet ‘Understanding Bladder Cancer’ and ‘Intravesical Chemotherapy’.

After an hour or so the drug is drained out through the catheter.

There is no alternative treatment to diagnose a bladder cancer.

Common

• Mild burning or bleeding on passing urine for a short period after the operation.
• Temporary insertion of a catheter for bladder irrigation.
• Need for additional treatments to bladder in attempt to prevent recurrence of tumours Including drugs installed into the bladder.

Occasional

• Infection of the bladder requiring antibiotics.
• No guarantee of cancer cure by this operation alone.
• Recurrence of bladder tumour and/or incomplete removal of tumours.

Rare

• Delayed bleeding requiring removal of clots or further surgery.
• Damage to drainage tubes from kidney (ureters) requiring additional therapy.
• Injury to urethra causing delayed scar formation.
• Perforation of the bladder requiring a temporary urinary catheter or open surgical repair.

TURBT normally takes between 30 – 40 minutes to perform, although having an anaesthetic makes this time longer. The whole procedure takes about 60 minutes.