Transurethral bladder resection

Encyclopedia of Medicine, Apr 06, 2001 by Kathleen Dredge Wright

Transurethral bladder resection is a surgical procedure, performed under sedation or anesthesia, with a lighted tube inserted through the urethra (the small tube-like structure that allows urine to empty from the bladder), into the bladder. It plays both a diagnostic and therapeutic role in the treatment of bladder cancers.

Tranurethral resection is the initial form of treatment for bladder cancers. The procedure is performed to remove and examine bladder tissue and/or tumor. It may also serve to remove lesions and be the only treatment necessary for noninvasive tumors.

For this procedure, a lighted tube (resectoscope) is inserted through the urethra, into the bladder. A clear solution is infused to maintain visibility, and the tumor or tissue to be examined is cut away using an electric current. Tumor and muscle fibers are biopsied (a sample is cut out and examined, usually under a microscope) in order to evaluate the depth of tissue involvement, while avoiding perforation of the bladder wall. Every attempt is made to remove all visible tumor tissue, along with a small border of healthy tissue. The resected tissue is examined under the microscope for diagnostic purposes. An indwelling catheter may be inserted to ensure adequate drainage of the bladder postoperatively. At this time, interstitial radiation therapy may be initiated if necessary.

Preoperative x rays with dye studies are helpful as a guide in determining the character and extent of tumor involved. As with any surgical procedure, the patient is asked to sign a consent form, after the procedure is thoroughly explained.

As with any surgical procedure, blood pressure and pulse will be monitored. Urine is expected to be blood-tinged in the early postoperative period. Continuous bladder irrigation (rinsing) may be used for approximately 24 hours after surgery. Most operative sites should be completely healed in three months. The patient is followed closely for possible recurrence with visual examination, using a special viewing device (cystoscopic) at regular intervals as the physician deems necessary.

Complications of the procedure may include bleeding, which may require bladder irrigation postoperatively, during which time the patient's activity is limited to bedrest. Perforation of the bladder is another risk, in which case the urinary catheter is left in place for four to five days postoperatively. The patient is started on antibiotic therapy preventively. If the bladder is lacerated, accompanied by spillage of urine into the abdomen, an abdominal incision may be required.

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