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    Urosurgery:
 
 

TUR-Bladder Tumour:

T.U.R.-Bladder Tumour is removal or resection of the urinary bladder tumour with the help of an endoscopic cutting device that is inserted into your urinary bladder via your urethra.

Transurethral approach vs. Open approach - What is the difference?

  • Endoscopic Surgery
    • Transurethral Resection of Bladder Tumour - This procedure is usually performed when the tumour is confined to a section of the bladder.
    • Cystoscopic removal of Bladder Tumour - In this method, the bladder tumour (small) is removed with a Cystoscope same as a stone is removed from the bladder.
  • Open Surgery
    • Partial Cystectomy - The bladder is approached through an incision in the abdomen and the tumour is containing part of the bladder is removed.
    • Complete, Radical or Total Cystectomy - This surgery is performed when the tumour is large and has advanced (muscle invasive bladder cancer) to involve the surrounding structures like the ureters, urethra, vagina and the uterus (in women) and in men it may involve the prostate gland and the seminal vesicles. While performing a Total Cystectomy in men, the nerve bundles that are responsible for urinary incontinence, erection and orgasm may be cut inadvertently. Cystectomy is a better option in case of advanced bladder cancer to ensure complete removal of the cancer. Following Total Cystectomy, reconstruction of bladder is performed from the bowel tissue.

What is the carcinogen profile of bladder cancer?

  • The most important is tobacco smoking.
  • Chronic (low grade) and recurrent urinary tract infection.
  • Occupational hazard - people working with materials like dyestuffs, rubber compounds, leather, print and petroleum
  • Excessive use of phenacetin containing drugs
  • Schistosomiasis, infection of the bladder caused by a worm called Schistosoma Hematobium.

Who is an ideal candidate for T.U.R.-Bladder Tumour?

If you have a cancerous or non-cancerous growth of the urinary bladder, that is small and is confined to the urinary bladder and has not spread to the surrounding structures, then you are an ideal candidate for T.U.R.-Bladder Tumour.

How do I prepare for T.U.R.-Bladder Tumour?

Routine blood and urine analysis, CT of abdomen and chest x-ray will be requested by your physician on your pre-oparative consult. Inform your physician about your other health conditions and medications (including all the prescription, non-prescription medications, nutritional supplements i.e. vitamins, minerals and herbal products). Refrain from taking aspirin or Ibuprofen at least 2 weeks before T.U.R.-Bladder Tumour. Stop smoking a few weeks before T.U.R.-Bladder Tumour to prevent healing problems during recovery period. Do not eat or drink anything for at least 10 hours before the T.U.R.-Bladder Tumour surgery. You will be instructed to be hospitalized the night before the surgery.

What does the procedure for T.U.R.-Bladder Tumour involve?

T.U.R.-Bladder Tumour is performed under general anesthesia or spinal block with sedation. A Cystoscope is inserted via the urethra up into the bladder. The bladder is filled with fluid so that it is easily visualized from inside. The prostate gland is examined, a surgical loop is inserted through the Cystoscope to remove the portion of the enlarged prostate. A catheter is left in the bladder to allow for urine to flow easily for several days after the procedure. The entire procedure of T.U.R.-Bladder Tumour may take about one hour.

What is the recovery period like following T.U.R.-Bladder Tumour?

You will spend the next couple of hours in the recovery room under observation following T.U.R.-Bladder Tumour. Your vital signs, circulation and respiration will be closely monitored. You will also be closely monitored for any immediate post-operative complications like excessive bleeding. A foley's catheter will be retained in your urinary bladder to drain urine which may be blood tinged or may contain clots. You will experience some pain and discomfort which can be alleviated by the use of pain medication. Keep the operation area clean, avoid heavy lifting and sexual activity for 3 - 4 weeks. You will be able to get back to your normal activities in 4 - 6 weeks time following T.U.R.-Bladder Tumour.

What is the outcome of T.U.R.-Bladder Tumour?

The outcome of T.U.R.-Bladder Tumour depends on the type of tumour which is determined on histopathological examination of the tissue. In case of transitional cell carcinoma of bladder, it is not uncommon for the tumour to appear at another site i.e. the kidney or ureters. The procedure of T.U.R.-Bladder Tumour is quite successful in removing localized bladder tumour.

Benefits of T.U.R.-Bladder Tumour

T.U.R.-Bladder Tumour is considered to be a minimally invasive procedure and can be a treatment of choice for patients who are at high medical risk for anesthesia or a major operation such as Radical Cystectomy. This method of treatment has reduced risk of damage to the nerve bundles during the surgery resulting in incontinence or impotence neither should it effect in your sex drive.

Risks of T.U.R.-Bladder Tumour

  • Infection (Urinary tract infection)
  • Excessive bleeding
  • Blood clots in urine
  • Perforation of urethra or urinary bladder
  • Incontinence (rare)
  • Impotence (rare)
  • Infertility (rare)

Alternatives to T.U.R.-Bladder Tumour

Cystectomy - Partial or Total Cystectomy is the treatment of choice if the bladder tumour cannot be accessed through the transurethral route or if the cancer is advanced and has spread to the surrounding tissues.
Intravesicular treatment - In Intravesicular therapy procedure, liquid medicine is inserted directly into the bladder with a catheter. The advantage of Intravesicular Therapy is that it acts locally on the bladder cancer and minimizes the side effects that accompany systemic use of therapeutic drugs.
Chemotherapy - This treatment option is effective in especially in advanced or metastatic bladder cancer.
Radiation therapy - External-beam irradiation is sometimes used as a palliative measure.
Immunotherapy - Bacille Calmette-Guerin or BCG consists of live, attenuated bacteria that are effective in stimulating the immune system to kill cancer cells.

Description of the Procedure

A specialized cystoscope (a thin, lighted tube used to examine the bladder) is inserted into the urethra via the penis and up into the bladder. The bladder is filled with a solution, so that the surgeon can better see its interior. The prostate gland is examined through the scope. The surgeon inserts a surgical loop through the cystoscope to remove the portion of the prostate that has become enlarged. A catheter is left in the bladder to allow for urine flow for several days after the procedure, and may also be used to flush the bladder to remove accumulated blood clots.

After Procedure

Removed tissue is sent to a lab and analyzed

How Long Will It Take?

About one hour

Will It Hurt?

For several days after the surgery, you may feel some pain. The catheter may cause some discomfort.

Possible Complications:

TURP Syndrome (occurs in about 2 percent of patients, usually within the first 24 hours); symptoms include:

  • Increase or decrease in blood pressure
  • Bradycardia (slow heart action) or abnormal heart rhythm
  • Tachypnea (increased rate of respiration)
  • Nausea or vomiting
  • Blurred vision
  • Confusion
  • Agitation
  • Coma and shock in serious case
  • Infection
  • Incontinence
  • Retrograde ejaculation
  • Erectile dysfunction
  • Thrombophlebitis (blood clots in the superficial veins)
  • Excessive bleeding
  • Average Hospital Stay: 2–5 days

Postoperative Care:

  • There will be a catheter in your bladder to drain urine. The urine may be bloody, but do not be alarmed. This is normal. Water may be flushed through the catheter into your bladder to wash out blood and clots.
  • Always keep the catheter drainage bag below the level of your bladder.
  • Do breathing and coughing exercises regularly.
  • Rest in bed until the next morning and perhaps longer. The nurse can assist you the first time you get out of bed.
  • Clean the area where the catheter enters the urethra several times a day with soap, water, and a washcloth.
  • Drink lots of fluids, especially during the day, to help flush your bladder.
  • Avoid heavy lifting or exertion for three to four weeks.
  • Avoid sexual activity for four to six weeks after surgery.
  • Avoid consumption of alcohol, caffeine, and spicy foods that may over-stimulate the bladder.

Outcome

Recovery from surgery should take about three weeks. Symptoms such as frequent or painful urination will continue for a while but should lessen during the first six weeks. If there is blood in your urine, lie down, relax, and drink a glass or two of fluid. The next time you urinate the bleeding should have stopped. If it doesn't, call your doctor.

Although sexual activity should be avoided for four to six weeks after surgery, the TURP procedure should not affect your sex drive or ability to have sex. The procedure may damage the muscle valve located at the bladder that directs semen into the urethra and out the penis. If this happens, most of your sperm will flow into your bladder and be expelled when you urinate (this is called retrograde ejaculation). This should not, however, be considered a method of birth control. Some sperm may make it into ejaculation. If you are hoping to conceive children in the future, talk to your doctor about the possibility of developing retrograde ejaculation after the TURP.

 

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