Procedure of Bladder Tumor Removal

Bladder tumor removal can be a serious medical condition, often requiring surgical intervention to remove the abnormal growth. Whether benign or malignant, early diagnosis and prompt treatment are essential for better outcomes. In this blog, we explore the procedure of bladder tumor removal, covering everything from diagnosis to post-operative care.

The most common and effective treatment for early stage bladder tumors is surgical removal, primarily through a procedure known as Transurethral Resection of Bladder Tumor (TURBT). This minimally invasive technique allows surgeons to remove the tumor without making any external incisions, ensuring quicker recovery times and fewer complications. For more advanced cases, other surgical interventions such as partial or radical cystectomy may be considered.

Understanding Bladder Tumors

A bladder tumor is an abnormal growth of cells within the bladder lining or walls. Most bladder tumors originate from the urothelium, the inner lining of the bladder, and can range from non-invasive (confined to the lining) to invasive (spreading to the muscle layer or beyond). The most common type is transitional cell carcinoma, also known as urothelial carcinoma.

Bladder tumors can cause symptoms such as blood in the urine (hematuria), frequent urination, pain during urination, and pelvic discomfort. However, some tumors may be asymptomatic and are discovered during imaging or routine checkups.

Procedure of Bladder Tumor Removal

1. Diagnosing a Bladder Tumor :- The diagnosis of a bladder tumor typically begins with a urine analysis and urine cytology to detect abnormal cells. Imaging studies such as ultrasound, CT urography, or MRI provide a clearer picture of the tumor’s size and location.

   The most definitive diagnostic tool is cystoscopy, a procedure in which a urologist inserts a thin tube with a camera into the bladder through the urethra. During cystoscopy, the doctor may take a biopsy of suspicious areas, which is then examined under a microscope to determine whether the tumor is benign or malignant.

2. Treatment Options for Bladder Tumors :- Bladder tumor treatment depends on the tumor type, stage, grade, and overall health of the patient. For early stage tumors, especially non muscle invasive bladder cancer, surgical removal is often the first line of treatment. This is usually followed by intravesical therapy to reduce recurrence risk.

   For muscle-invasive tumors, more extensive surgery such as radical cystectomy (removal of the entire bladder) may be necessary, often combined with chemotherapy or radiation therapy.

   Let’s focus now on the surgical procedure most commonly used for bladder tumor removal: Transurethral Resection of Bladder Tumor (TURBT).

What is Transurethral Resection of Bladder Tumor (TURBT)?

TURBT is the standard surgical procedure used to remove bladder tumors that are non-invasive or limited to the superficial layers of the bladder. It is a minimally invasive, endoscopic procedure that does not require any external incisions.

During TURBT, the surgeon uses a resectoscope, a special instrument passed through the urethra into the bladder. The resectoscope is equipped with a camera and an electric wire loop that cuts away the tumor and cauterizes the area to minimize bleeding.

This procedure allows both removal of the tumor and biopsy for staging and grading, which are essential for determining the next steps in treatment.

Preparing for TURBT Surgery

Before undergoing TURBT, patients are typically evaluated for anesthesia fitness and may need to undergo additional lab tests, ECG, and imaging. The doctor may advise stopping certain medications such as blood thinners several days before surgery to reduce the risk of bleeding.

Fasting is usually required for 6–8 hours before the procedure. Patients are advised to arrange for someone to accompany them on the day of surgery, as they may not be able to drive post-procedure.

How the TURBT Procedure is Performed?

The TURBT procedure is generally performed under regional (spinal) or general anesthesia, depending on the patient’s condition and surgeon’s preference. The patient is positioned on their back with legs elevated in stirrups.

The steps include

1. Inserting the resectoscope through the urethra into the bladder.

2. Visualizing the tumor and assessing its size, location, and appearance.

3. Using the wire loop to shave off the tumor in layers.

4. Sending tissue samples for histopathological examination.

5. Controlling any bleeding by cauterization or flushing.

6. Placing a catheter in the bladder to drain urine and reduce clot formation.

The procedure typically lasts between 30 to 90 minutes, depending on the tumor size and complexity.

Recovery After TURBT Surgery

After the surgery, the patient is moved to the recovery room and monitored for a few hours. If there are no complications, they may be discharged the same day or the following day.

The catheter placed during surgery usually remains for 1–2 days. Some common post-operative experiences include

1. Mild burning sensation during urination

2. Blood tinged urine for a few days

3. Frequent urges to urinate

Pain and discomfort are usually managed with oral medications. Patients are encouraged to drink plenty of fluids to flush out the bladder and prevent infections.

Possible Risks and Complications

TURBT is generally safe but, like any surgical procedure, it carries potential risks. These include

1. Bleeding or blood clots in the urine

2. Bladder perforation (rare)

3. Urinary tract infection

4. Temporary difficulty in urination

5. Tumor recurrence

In rare cases, if the tumor is deeply invasive or widespread, TURBT may not be curative and further treatment such as intravesical BCG therapy or radical surgery may be needed.

Follow Up and Monitoring

After bladder tumor removal, regular follow up is crucial. Bladder cancer has a relatively high recurrence rate, so patients must undergo periodic cystoscopy exams every 3–6 months initially, and then annually.

In some cases, intravesical therapy is administered post-TURBT, especially for high grade tumors. This involves instilling medications directly into the bladder to kill residual cancer cells and prevent recurrence.

Lifestyle and Prognosis

The prognosis after bladder tumor removal varies based on the tumor type and stage. Non-muscle invasive bladder cancer has an excellent prognosis if caught early and treated properly. However, long term surveillance is necessary.

Patients are encouraged to

1. Quit smoking (a major risk factor for bladder cancer)

2. Maintain a healthy diet

3. Stay hydrated

4. Adhere strictly to follow-up schedules

Conclusion

Bladder tumor removal, particularly through TURBT, is a vital and effective procedure for managing early stage bladder cancer. It offers the dual benefit of diagnosis and treatment with minimal invasiveness. While recovery is usually smooth, ongoing monitoring and lifestyle adjustments play a key role in maintaining bladder health and preventing recurrence.