If bladder cancer is diagnosed it generally requires biopsy to confirm the pathology and to help stage the extent of the cancer. In the bladder this type of information is collected by performing a transurethral resection of bladder tumor (TURBT). TURBT is performed in the operating room with endoscopic or telescopic instruments that can pass through the urethra into the bladder to scrape out all visible bladder tumors. When scraping out this tumor with TURBT it is important to collect enough information to decide whether the tumor has invaded the bladder wall to a dangerous level. The bladder wall is made of a deep muscle and connective tissue layer and on top of this deep muscle and connective tissue layer is a superficial layer including the transitional cell lining and some superficial muscle tissue. Separating these layers is an area called the lamina propria. The lamina propria divides the superficial from the deep tissues. For accurate staging information the resection must be carried out deep enough to take some lamina propria tissue and some of the deep connective tissue with deep muscle tissue. A useful analogy might be to compare this resection with attempting to scrap some of the flooring from a second-floor room with a carpet. The carpet layer could represent the superficial tissue of the bladder with the padding under the carpeting representing the lamina propria and the plywood subflooring representing the deep tissues of the bladder wall.
To continue the analogy, when performing a TURBT resection it is important to take scrapings that are deep enough to scrape some of the carpet and the carpet liner and the plywood subflooring but it is important not to scrape so much tissue that you go all the way through the floor so that you can see the room below you. This is a delicate balance between taking enough tissue to make a firm assessment and diagnosis but not taking so much tissue that you create a hole in the bladder. When such a hole is created on TURBT it is called a perforation. Bladder perforation on TURBT can have serious consequences. If it is created in an area that connects directly into the abdomen (the peritoneal cavity) where the loops of bowel reside (this is generally at the very back wall and very top of the bladder) then immediate surgical exploration with an incision through the abdomen is usually required. Such a perforation, if untreated, can result in serious illness and even death. Such a perforation can also lead to spread of the bladder cancer. If a perforation of this nature occurs elsewhere in the bladder (such as along the side walls or anterior section or base of the bladder) then the consequences are far less serious. Such perforations that do not connect into the peritoneal cavity can be managed with simply keeping a bladder catheter in place for longer periods of time (such as five to ten days).
If a TURBT is uncomplicated and does not involve perforation the bladder catheter may be kept in place for two to seven days. In many cases no catheter is required at all. The TURBT is performed usually on an outpatient basis under anesthesia in the operating room. Therefore, patients commonly go home the same day of surgery with a catheter in the bladder and return to the office in two to seven days to have the catheter removed. It usually takes about one week to have the pathology report on the nature and the extent of the cancer. In some cases no catheter is required.
TURBT Post-Op Instructions
You may see some blood in your urine following TURBT for a few days afterwards. Do not be alarmed, even if the urine was clear for a while. Push fluids and refrain from strenuous activity until clearing occurs. If you have difficulty passing clots or don't improve, call us. You can also try sitting in a warm tub of water to help to urinate if needed.
Diet:
You may return to your normal diet immediately. Alcohol, spicy foods, acidy foods and drinks with caffeine may cause irritation or frequency and should be used in moderation. To keep your urine flowing freely and to avoid constipation, drink plenty of fluids during the day (8-10 glasses).
Activity:
For about two weeks following TURBT do not engage in strenuous activity or heavy lifting. If you are active, you may see more blood in the urine. We would suggest cutting down your activity under these circumstances until the bleeding has stopped.
Bowels:
It is important to keep your bowels regular during the postoperative period. Straining with bowel movements can cause bleeding. A bowel movement every other day is reasonable. Use a mild laxative if needed, such as Milk of Magnesia 2-3 tablespoons, or 1-2 Dulcolax tablets. Call if you continue to have problems. Narcotics can worsen constipation; if you had been taking narcotics for pain, before, during or after your surgery, you may be constipated. Ditropan for bladder spasms may also cause constipation.
Problems you should report to us:
- Fevers over 101.5 degrees Fahrenheit.
- Inability to urinate.
- Drug reactions (hives, rash, nausea, vomiting, diarrhea).
- Severe burning or pain with urination that is not improving.
You will also have some burning with urination. This burning should be mild or moderate and should improve over time. Severe burning, especially when it is not improving, can be a sign of infection.
Follow-up
If a catheter is placed please call the office for this appointment at (302) 836-5500 or (302) 571-8958 to schedule foley catheter removal. Whether or not the catheter is removed the next step could be for cystoscopy in 1-3 months in the office or operating room depending on the pathology.
POST OP MEDICATIONS:
You will need three medications for this procedure and in most cases we can dispense a prescription for these medications when you schedule your procedure. The medications are:
- An antibiotic:
Septra DS taken by mouth twice a day for three days
Cipro 250mg taken by mouth twice a day for three days
Keflex 250mg taken by mouth four times a day for three days
- An anticholinergic:
Ditropan 5 mg by mouth every 6-8 hours for the first few days, Then as needed for bladder spasms
- A pain pill: One of the following will be prescribed for pain control
Vicodin (Hydrocodone/APAP) 5/500mg. 1-2 tabs by mouth every 6 hours as needed for pain
Percocet 5/325mg. 1-2 tabs by mouth every 6 hours as needed for pain.
Dilaudid 2mg. 1-2 tabs by mouth every 6 hours as needed for pain.
