Why is it done?

Primary management of:

• Resect a bladder lesion suspicious of bladder cancer
• Three Types of bladder cancer:

1. • Urothelial Carcinoma (85%)
   • Squamous Cell carcinoma
   • Adeno carcinoma

• Metastatic cancer to the bladder – i.e. Breast, Cervical, Adeno carcinoma of bowel.
• Other space occupying lesions in the bladder: infection granulomas, abscess from diverticulitis etc.
• Abnormal cells suggestive of urothelial carcinoma, on urine cytology.

Risk factors:

• Strong family history of bladder cancer.
• Smokers or passive smokers.
• Factory workers: dyes, paints, etc.
• Exposure to Schistosoma (Bilharzia).
• Renal stone disease, bladder stones.

How is it done?

• This is done under General anesthesia.

• A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant gel and saline irrigation.
• The bladder is then distended with saline.
• A resectoscope is then placed.
• I use Bi-polar resection, thus using saline as irrigation.
• The tumour or tumours are resected as complete as possible.
• Deep resection of the tumour base is done to exclude deep muscle invasive tumours.
• In tumours where it is clearly muscle-invasive, less extensive surgery is done, as this patient may benefit from a cystectomy.
• 40mg of Intravesical Mitomycin C is routinely placed inside your bladder for an hour after the surgery.
• A 3-way catheter is placed with continuous saline irrigation until your urine is clear.
• Antibiotics may be given to prevent infection.

Mitomycin C

Chemotherapeutic agent providing 40% lower incidence of Urothelial Cancer recurrence if placed within 6-8 hours inside the bladder after a TURBT.

What to expect after the procedure?

• Blood stained urine.
• Lower abdominal discomfort which will persist for a few days.
• Catheter induced discomfort.
• NB! Each person is unique and for this reason symptoms vary.
• Small risk (<1%) of bladder perforation, causing you to have a laparoscopy with repair of bladder and wash-out of peritoneal cavity with Sterile Water.

What next?

• You may have a 22 French (thick) 3-way urethral catheter placed through your urethra.
• It does have a channel for placement of constant saline irrigation and another for the drainage of the blood-stained urine.
• The continuous bladder irrigation will continue until your urine is clear approximately 24-48hrs.
•  This can also be remedied by drinking plenty of fluids until it clears.
• As soon as the colour of your urine is satisfactory, your catheter will be removed.
• Staging of your cancer will be arranged to be reviewed on your review appointment.
• A ward prescription will be issued to patients on discharge, for own collection at any pharmacy.
• Patients should schedule a follow-up appointment within 7-14 days.
• Please don’t hesitate to direct all further queries to Jo.
• REMEMBER: THOSE WHO SUFFER IN SILENCE, SUFFER ALONE!

Staging

• CT IVP.
• CT Chest.
• Bone scan.
• Renal Function and Liver Function Tests.
• MRI where an allergy to Iodine or Renal Impairment.

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Wes TURBT