Dr Jo Schoeman
Urological Surgeon

        

Trans-urethral Resection of Bladder Tumour

Product Summary: AMA rates

Trans Urethral resection of bladder tumour with MMC: 2cm, 2cm/multiple

Item numbers: 36840, 13948, 105; 36845, 13948, 105

An endoscopic procedure where bladder tumours are excised via the Urethra. This is done under GA.

Why is it done?

Primary management of:

  • Resect a bladder lesion suspicious of bladder cancer
  • Three Types of bladder cancer:
    • Urothelial Carcinoma (85%)
    • Squamous Cell carcinoma
    • Adeno carcinoma 
  • Metastatic cancer to the bladder – i.e.: Breast, Cervical, Adeno carcinoma of bowel.
  • Other space occupying lesions in the bladder: infection granulomas, Abcess from diverticulitis etc.
  • Abnormal cells suggestive of urothelial carcinoma, on urine cytology.

Risk factors:

  • Strong family history of bladder cancer.
  • Smokers or passive smokers.
  • Factory workers: dyes, paints, etc.
  • Exposure to Schistosoma (Bilharzia).
  • Renal stone disease, bladder stones.

How is it done?

  • This is done under General anaesthesia.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant gel and saline irrigation.
  • The bladder is then distended with saline.
  • A resectoscope is then placed.
  • I use Bi-polar resection, thus using Saline as irrigation.
  • The tumour or tumours are resected as complete as possible.
  • Deep resection of the tumour base is done to exclude deep muscle invasive tumours.
  • In tumours where it is clearly muscle invasive, less extensive surgery is done, as this patient may benefit from a cystectomy.
  • 40mg of Intravesical Mitomycin C is routinely placed inside your bladder for an hour after the surgery.
  • A 3 way catheter is placed with continuous saline irrigation until your urine is clear.
  • Antibiotics may be given to prevent infection.

Mitomycin C

Chemotherapeutic agent providing 40% lower incidence of Urothelial Cancer recurrence if placed within 6-8 hours inside the bladder after a TURBT.

What to expect after the procedure?

  • Blood stained urine.
  • Lower abdominal discomfort which will persist for a few days.
  • Catheter induced discomfort.
  • NB! Each person is unique and for this reason symptoms vary.
  • Small risk (<1%) of bladder perforation, causing you to have a laparoscopy with repair of bladder and wash-out of peritoneal cavity with Sterile Water.

What next?

  • You may have a 22 –24 French ( thick) 3 way urethral catheter placed through your urethra.
  • It does have a channel for placement of constant slaine irrigation and another for the drainage of the blood-stained urine.
  • The Continuous baldder irrigation will continue until your urine is clear approximately 24-48hrs.
  •  This can also be remedied by drinking plenty of fluids until it clears.
  • As soon as the colour of your urine is satisfactory, your catherer will be removed.
  • Staging of your cancer will be arranged to be reviewed on your review appointment.
  • A ward prescription will be issued to patients on discharge, for own collection at any pharmacy.
  • Patients should schedule a follow-up appointment within 7-14 days.
  • Please don’t hesitate to direct all further queries to Jo.
  • REMEMBER: THOSE WHO SUFFER IN SILENCE, SUFFER ALONE!

Staging

  • CT IVP.
  • CT Chest.
  • Bonescan.
  • Renal Function and Liver Function Tests.
  • MRI where allergy to Iodine or Renal Impairment.

Trans-Urethral Resection of Bladder Tumour Trans-Urethral Resection of Bladder Tumour (255 KB)