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Many people are diagnosed with bladder cancer each year. Bladder tumor resection is often curative, but it also provides information and a diagnosis in terms of aggressiveness of the tumor, chances of cure and recurrence.
No incisions! That’s the good part. The entire procedure is done under general anesthesia (asleep) via the urethra (penis). We now utilize state-of-the-art high definition cameras to visualize the bladder. We then use plasma-vaporization devices to basically remove the bladder tumor. The best way to think of a bladder tumor is that it is a weed. Just like weeds, there are weeds with superficial roots that you can pluck right out, and there are weeds with deep roots that despite pulling, you can’t completely pull them out.
For superficial tumors, TURBT is often curative (fully treated). For deeper tumors, further treatment is necessary.
For some patients, at the conclusion of the case, we utilize a medicine such as Mitomycin-C (I call it my version of weed-killer) to reduce the chance of bladder tumor recurrence.
TURBT is usually performed in the hospital or outpatient surgical center, and takes approximately 1 hour.
It is critical that you stop any Aspirin, Coumadin, Plavix, or other blood thinners one week before TURBT. Please call our office should you have any questions about this. The night before your procedure, you may eat and drink as usual. However, do not take anything by mouth after 12:00 midnight the night before. Wear comfortable, loose-fitting clothing like a jogging suit on the day of your procedure. Bring a list of all the prescription and nonprescription medications that you take regularly with you on the day of the procedure.
Please plan to arrive two hours prior to your treatment.
The TURBT usually takes approximately 1 hour, and Dr. Shaw will come and speak to your family afterwards.
Upon waking from the procedure, you will have a catheter draining your bladder. I have yet to meet a person who likes having a catheter, but relax, the catheter typically will remain for 3-5 days and then be removed in clinic. Because we have effectively removed a small part of the bladder with the tumor removal, this needs to heal, or seal back up. A catheter for a few days accomplishes this.
It is common for the catheter to drain pink or red urine. Just as Kool-Aid can turn water red with just a small amount of coloring, just a small amount of blood turns the urine red. If there are clots, or more significant blood in the urine, Dr. Shaw may opt to keep you in the hospital overnight and discharge you in the morning.
You will be given full instructions from our nurse on how to manage, and drain the foley catheter bag when it gets full.
It is not unusual to have a sensation of wanting to urinate, or to have bladder spasms after surgery. This usually goes away within 1-2 days. You may occasionally notice a small amount of urine leak around the catheter, and this is normal.
After the procedure, patients may have a variety of minor issues. Although many patients may do fine with no issues, some patients may experience minor, temporary issues such as noticing burning with urination, frequent urination, small clots, or pink/red colored urine, or occasional discomfort that radiates from the kidney to the bladder. Again, these usually tend to be minor issues, and resolve within 1-2 days after the procedure. Definitely rest up for a day or two after a TURBT. Drink at least 6-8 glasses of water to wash out your system. Within a day or two, your urine will begin to clear up and look ‘normal’.
For pain, Advil®, Motrin®, or prescription Toradol® work great – dependent upon your doctor’s advice. Never take a medication without clearing it with your doctor first. These are non-narcotic, so you don’t get sleepy, constipated or have other issues; however they are great anti-inflammatories. Take them on a regular basis the first 2-3 days after the procedure. For pain not relieved by these medications, use the prescription Tylenol with Codeine or Vicodin that was prescribed for you. We may also occasionally give you a few days of bladder spasm medication.
Do not strain when having a bowel movement. Expect irregular bowel habits until fully recovered. Increase fiber in your diet. You may need a stool softener or laxative. Do not take blood thinners or aspirin products for one week or as directed by your physician.
Take it easy for the first 48 hours after the procedure. Do not drive or operate dangerous equipment for 48 hours following anesthesia. You may be able to resume non-strenuous activities after 48 hours unless otherwise directed by your physician. Avoid strenuous exercise, heavy lifting greater than 20 pounds, bike riding, and yard work for two weeks, as the vibrations and movement may cause bleeding. No sexual activity for two weeks after surgery.
You will need a catheter to drain your bladder, depending upon the extent of your surgery. Catheters generally are removed within a few days in the Urology Clinic. Wash around the catheter with soap and water and rinse well. You may shower, but avoid baths until the catheter is removed.
Avoid coffee, tea, carbonated beverages, alcoholic beverages,citrus juices, spicy foods and smoking for the first month week following surgery.Increase your intake of fluids, particularly water – at least 6-8 glasses of water are typically recommended during the first two weeks of your recovery.
You may experience urinary urgency and/or frequency for the first month following surgery. This is normal. Talk to your doctor to discuss medications that may relieve this. You may have a small amount of bleeding with urination on occasion. This may be accompanied with small blood clots. This is normal, and should be relieved by increasing your fluid intake. You may experience some mild burning and discomfort during urination. This is normal and should subside in one to two to four weeks.
Usually, Dr. Shaw or his staff will communicate to you a desired followup time frame. Please call us the day after the procedure to verify a time to see us in the office, and to remove your catheter.
The only problem with bladder tumors, is that just like weeds, they have a nasty habit of coming back. The problem is that the source of the bladder tumor, which 90% of the time is associated with smoking, has affected the entire bladder. And those effects are long lasting. That means that we place each of our patients through a very rigorous, scientifically validated protocol for surveillance of tumor recurrence. The great news is that bladder cancer, when detected early, and managed properly, can be managed with good outcomes.