Complications of Bladder Tumor Removal

Bladder tumor removal is a commonly performed procedure, often done through a minimally invasive approach called transurethral resection of bladder tumor (TURBT). While this surgery is generally safe and effective in removing bladder tumors, like all medical interventions, it carries a risk of complications. Understanding these potential risks can help patients prepare better, manage expectations, and recognize warning signs early in the recovery process.

Just like any surgery, bladder tumor removal comes with its own set of potential complications ranging from minor bleeding and urinary discomfort to more serious outcomes such as bladder perforation, infection, or long term recurrence. These complications can be influenced by several factors, including the type and stage of the tumor, the overall health of the patient, and the specific surgical technique used.

What is Bladder Tumor Removal?

Bladder tumor removal is most commonly performed using a technique called TURBT (Transurethral Resection of Bladder Tumor). This is a minimally invasive procedure done through the urethra, which eliminates the need for external incisions. TURBT is typically used for early-stage bladder cancers or to diagnose and determine the grade and stage of the tumor.

For larger or more invasive tumors, more complex surgeries like partial or radical cystectomy (removal of part or all of the bladder) may be necessary. These extensive procedures have a different complication profile, but even simple TURBT can lead to various short or long term issues.

Common Complications of Bladder Tumor Removal

Although most patients recover well after bladder tumor surgery, some may experience complications. These can be categorized as immediate (within days), short-term (within weeks), and long-term (months to years later).

1. Bleeding and Hematuria :- One of the most common complications after bladder tumor removal is bleeding. Patients often pass blood in their urine (hematuria), which can range from mild pinkish discoloration to bright red urine with clots.

   • Mild bleeding is normal and typically resolves within a few days.

   • In some cases, heavy bleeding may require bladder irrigation or even a repeat procedure to control it.

   • Rarely, a blood transfusion may be necessary if blood loss is significant.

2. Bladder Perforation :- Bladder perforation is a rare but serious complication. During TURBT, especially for large or deeply situated tumors, the bladder wall may be accidentally punctured.

   • Most perforations are small and can heal on their own with catheter drainage.

   • Larger perforations may need surgical repair.

   • Symptoms can include abdominal pain, fever, and inability to urinate.

   This risk is higher in patients with thin bladder walls, those who have had previous bladder surgeries, or those with large tumors.

3. Urinary Tract Infection (UTI) :- UTIs are fairly common after any urological procedure. Bladder tumor removal may lead to temporary irritation or exposure of internal tissues, which can allow bacteria to enter the urinary tract.

   Symptoms may include

   • Burning during urination

   • Fever

   • Urgency and frequency

   • Foul smelling or cloudy urine

   These infections usually respond well to antibiotics but should be treated promptly to avoid kidney involvement.

4. Painful Urination and Bladder Irritation :- After the surgery, many patients experience dysuria (painful urination) or a constant urge to urinate. This is usually due to temporary inflammation of the bladder lining and should subside within a few days to a week.

   However, in some cases, persistent pain may indicate infection, residual tumor tissue, or a more serious problem.

5. Bladder Scarring and Reduced Capacity :- Repeated TURBT procedures, especially over several years, can lead to bladder wall scarring. This may result in reduced bladder capacity, causing

   • Frequent urination

   • Nighttime urination (nocturia)

   • Urgency

   Though not dangerous, this can impact the patient’s quality of life and may require long-term management strategies.

6. Urinary Incontinence :- While not very common after TURBT, urinary incontinence may occur, especially if multiple surgeries have been done or if the bladder muscle has been affected.

   Incontinence can range from occasional leakage to complete loss of control. Pelvic floor exercises, medications, and in some cases, surgical intervention may be needed.

7. Sepsis :- In rare cases, a urinary infection may spread to the bloodstream, leading to sepsis, a life threatening condition. This requires immediate hospitalization and intravenous antibiotics.

   Early signs include high fever, chills, rapid heart rate, confusion, and low blood pressure.

8. Tumor Recurrence and Progression :- One of the biggest challenges in bladder cancer management is the high recurrence rate. Even after successful removal, bladder tumors often return. Some tumors may also progress to more invasive stages.

   To monitor this, patients undergo regular cystoscopic surveillance and may receive intravesical therapy (e.g., BCG treatment) to reduce recurrence.

Managing and Preventing Complications

While not all complications can be prevented, several strategies can minimize the risks

1. Follow Preoperative Instructions :- Proper hydration, avoiding blood thinners, and controlling infections before surgery help reduce intraoperative risks.

2. Postoperative Monitoring :- Watching for symptoms like severe bleeding, high fever, or inability to urinate is crucial.

3. Attend Follow Up Visits :- Regular follow ups help catch early signs of recurrence or other complications.

4. Report Symptoms Early :- Don’t ignore discomfort, persistent pain, or abnormal urinary symptoms.

Recovery After Bladder Tumor Removal

Most patients recover from TURBT within 1 to 2 weeks. The catheter is usually removed after 1–2 days, and normal activities can resume shortly after, with the exception of heavy lifting and strenuous exercise for a few weeks.

Patients who receive intravesical therapy such as BCG may have additional symptoms like bladder irritation, fatigue, or low-grade fever, which are usually manageable.

In the case of radical cystectomy, recovery may take several months and could involve learning to use a urinary diversion method, like an ileal conduit or neobladder.

When to Call Your Doctor?

It’s important to reach out to your healthcare provider immediately if you experience

1. Persistent or heavy bleeding

2. Fever above 100.4°F (38°C)

3. Severe abdominal pain

4. Difficulty or inability to urinate

5. Signs of infection such as chills or foul smelling urine

Conclusion

Bladder tumor removal, especially when done through TURBT, is a vital procedure in the diagnosis and management of bladder cancer. While it is generally safe and effective, it is not without risks. Understanding the potential complications from bleeding and infection to long-term recurrence is essential for patients undergoing this procedure.