Urology

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Endoscopic surgery of a bladder tumour

What does this procedure entail?

The procedure enables the detection and at the same time usually removal of a malignant tumour of the bladder. The surgery is performed using a telescopic instrument inserted through the urethra.

What are the alternatives to this procedure?

Intracystic application of anti-cancer agents – BCG vaccine, cytostatics
Open surgery – removal of the bladder – in case of extensive or otherwise unsolvable findings
Oncological treatment – chemotherapy, radiotherapy

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked not to eat or drink for at least 6 hours before the surgery!

In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.

Remember to inform your physician about the following possible facts before the surgery:

artificial heart valve
coronary artery stent
pacemaker
artificial joint
artificial vascular graft
neurosurgical bypass
other implanted foreign body
use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton  Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
drug and other allergies
any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first.

The procedure is performed exclusively under general anaesthesia. If the outer orifice of the urethra is too tight for the instrument, it must first be widened or cut.

After the insertion of the telescopic instrument through the urethra, the bladder wall is inspected and subsequently treated. If possible, all malignant or suspicious tissue is removed during the surgery. The samples are sent for histological examination. After the procedure, it is necessary to insert a temporary catheter into the bladder enabling the lavage. Depending on the extent and depth of the resection area, it can be there for 1-7 days.
This process takes between 45-60 minutes.

What will happen immediately after the procedure?

You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

Bladder bleeding is a common occurrence after the surgery. Blood in the urine disappears within 3-4 days. After the discharge, the urine is already clear. If blood loss is more significant, you will be given a blood transfusion. Revision (surgical control) may be considered in case of massive or persistent bleeding. You should be able to eat and drink in the evening after the surgery.
The catheter is removed during hospitalisation. Initially, urination may be painful and may be more frequent than usual, exceptionally with blood. The initial issues can be alleviated by medication. These problems usually disappear within a few days to weeks.
Exceptionally, the patient may not be unable to urinate spontaneously at all after this surgery. In this case, the catheter is inserted again so that the tissue may heal. The catheter is permanently removed days to weeks later.
The average length of stay in the hospital is 3-8 days, depending on the scope of the procedure and the postoperative course.

Once you are fully conscious, you should:

ask if the planned outcome was achieved
inform the medical staff about any problems
ask what you can and cannot do
ask all the questions you have for the healthcare professionals and members of the medical team.
remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

Temporary mild burning, bleeding and frequent urination after the procedure
Bladder, testicular or kidney infections requiring antibiotic treatment
Necessity of temporary urinary tract drainage using a permanent catheter (day to several days)
The need to undergo additional treatment to reduce the risk of recurrence of the tumour, e.g., instillation (short-term filling of the bladder with a therapeutic agent, e.g. cytostatics) immediately after the surgery, or during subsequent outpatient care.

Occasional (2-10% of procedures of this type)

Urinary tract infections
Incomplete removal of the tumour focus

Rare (2% of procedures of this type)

TUR syndrome caused by the absorption of a larger amount of lavage fluid into the bloodstream. It leads to increased blood pressure and heart rate, shortness of breath, headache with nausea or vomiting. Severe events can lead to unconsciousness or renal failure requiring dialysis.
Perforations (punctures, cuts) of the bladder wall requiring a longer use of the urinary catheter in the bladder (days to weeks), very rarely with the need for open surgery.
Bleeding requiring further surgery and/or blood transfusion.
Urethral injury causing scarring.

Hospital infections

MRSA colonisation (0.9% – 1 of 110)
Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

get recommendations on recovery at home
ask when you can return to normal activities such as work, exercise, driving, housework
get a contact number for further questions after returning home or in case of trouble
ask about the date of the following check-ups and the place where you should come (hospital or your attending physician)
make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs.

At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

What else should I watch out for?

If you experience more frequent problems, burning or difficulty urinating, or have unusual bleeding, consult your attending physician. Mild problems can be solved by increased fluid intake. If there is no improvement, you should see your doctor. In the event of severe bleeding, large amounts of clots or obstruction of the urethra, you should see your doctor immediately. They will probably refer you back to the hospital.

Any important information?

The results of the histological analysis of the collected tissue will be discussed at the postoperative check-up. Bladder cancer requires long-term follow-up with regular cystoscopic examinations at the urological site. If you are an active smoker, we strongly recommend that you quit smoking promptly. Tumour recurrences are up to 6 times higher in smokers than in the general population.

Most patients need 1-3 weeks of rest at home before they are able to handle a full workload. Before returning to work, we recommend a 3-4-week-long rest period, especially if you have a physically strenuous occupation. You should avoid lifting heavy loads at this time.