What does the procedure involve?
Telescopic removal of a bladder tumour with diathermy.
What are the alternatives to this procedure?
Alternatives to this procedure include open surgical removal of the bladder, chemotherapy and radiation therapy.
What should I expect before the procedure?
If you regularly take aspirin or clopidogrel, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. Stopping them may reduced the risk of bleeding but this can result in increased clotting, which may also carry a risk to your health. You will need to discuss the risks and benefits of the treatment with your GP or your urologist.
You will usually be admitted to hospital on the same day as your surgery. Once you have been admitted, you will be seen by members of the medical team which may include the consultant, anaesthetist and your named nurse.
You will be asked not to eat and drink for six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication which will make you dry-mouthed and pleasantly sleepy.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve
- A coronary artery stent
- A heart pacemaker or defibrillator
- An artificial joint
- An artificial blood-vessel graft
- A neurosurgical shunt
- Any other implanted foreign body
- A regular prescription for warfarin, aspirin or clopidogrel (Plavix®)
- A previous or current MRSA infection
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you are unable to feel anything from the waist down) will be used. All methods reduce the level of pain afterwards. Your anaesthetist will explain the pros and cons of each type of anaesthetic to you.
You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
A telescope is inserted into the bladder through the urethra (water pipe) and the surgeon will remove your tumour (pictured above) bit by bit using diathermy or a laser.
The tumour fragments are removed using suction and sent for pathology analysis and a bladder catheter is usually put in after the procedure.
Once the instrument is in place, the examination will only take a few minutes to complete. Attached to the instrument are a telescopic lens, a light source and some sterile water to fill the bladder so that all the lining can be inspected.
What happens immediately after the procedure?
You should be told how the procedure went and you should:
- ask the surgeon if it went as planned;
- let the medical staff know if you are in any discomfort;
- ask what you can and cannot do;
- feel free to ask any questions or discuss any concerns with the ward staff and members of the surgical team; and
- make sure that you are clear about what has been done and what happens next.
You will usually have a bladder catheter put into the bladder after this procedure. Before the catheter is removed, the chemical (Mitomycin C) may be instiiled into the bladder which reduces the risk of tumour recurrence in the bladder at a later date. This is left in the bladder for one hour, usually on the day of surgery.
Once your urine is clear, we will remove your bladder catheter and you will normally be allowed home once you have passed urine satisfactorily.
The average hospital stay is two to three days.
Are there any side-effects?
Most procedures have possible side-effects. But, although the complications listed below are well-recognised, most patients do not suffer any problems.
Common (greater than 1 in 10)
- Mild burning or bleeding on passing urine for short period after operation.
- Need for additional treatments to the bladder to prevent later recurrence of tumours.
Occasional (between 1 in 10 and 1 in 50)
- Infection of bladder needing antibiotics.
- No guarantee of cancer cure by this operation alone.
- Recurrence of the bladder tumour and/or incomplete removal.
Rare (less than 1 in 50)
- Delayed bleeding needing removal of clots or further surgery.
- Damage to drainage tubes from kidney (ureters) needing additional therapy.
- Injury to the urethra causing delayed scar formation.
- Perforation of the bladder needing a temporary urinary catheter or open surgical repair.
What should I expect when I get home?
When you are discharged from hospital, you should:
- be given advice about your recovery at home;
- ask when you can begin normal activities again, such as work, exercise, driving, housework and sex;
- ask for a contact number if you have any concerns once you return home;
- ask when your follow-up will be and who will do this (the hospital or your GP); and
- be sure that you know when you get the results of any tests done on tissues or organs that have been removed.
When you leave hospital, you will be given a “draft” discharge summary. This contains important information about your stay in hospital and your operation. If you need to call your GP or if you need to go to another hospital, please take this summary with you so the staff can see the details of your treatment. This is important if you need to consult another doctor within a few days of being discharged.
When you get home, you should drink twice as much fluid as you would normally for the first 24 to 48 hours to flush your system through and reduce any bleeding. You may notice some burning or pain in your lower abdomen initially, but this usually settles over a few days.
What else should I look out for?
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately.
Are there any other important points?
It will be 14 to 21 days before the biopsy results on the tissue removed are available. All biopsies are discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.
Depending on the biopsy results, further investigations (e.g. X-ray, CT scan), instillation of drugs into your bladder (chemotherapy or immunotherapy) or a further admission may be arranged for you. Your consultant or named nurse will explain the details of this to you in hospital.
Driving after surgery
It is your responsibility to make sure you are fit to drive following your surgery. You do not normally need to tell the DVLA that you have had surgery, unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to give you advice on this.