As you know, you have been diagnosed as having a superficial tumour inside your bladder. If you were able to see it, the tumour would look like a small mushroom or cauliflower. Superficial bladder cancer affects just a few layers of cells on the inner surface of the bladder. It is important to understand that the cancer has not grown roots into the deeper bladder muscle or outside of the bladder wall. If treated, there is very little chance of this type of tumour spreading although long term follow up is needed.
The tumour will usually have been diagnosed following a flexible cystoscopy for patients who have been found to have blood in the urine. Sometimes a tumour is seen on ultrasound or X ray examination of the bladder
Superficial bladder tumours are removed using a cystoscope. This is a special tube containing a small telescope, which is passed along the urethra ("water-pipe") into the bladder. The surgeon can first examine the inside of the urethra and the bladder and then, using special instruments the tumour or tumours can either be burned away (Cysto-diathermy or Laser ablation) or cut away (Trans urethral resection of Tumour, TURBT.) We also can use lasers to treat superficial bladder tumour recurrences.
If this is the first time the tumour has been diagnosed then the operation will be done under either spinal or general anaesthetic in order to allow removal of some of the bladder muscle beneath the tumour (this confirms the absence of any tumour invasion)
Cysto-diathermy/ Laser ablation
This operation is most often used for very small, recurrent bladder tumours. It is a minor operation, which is usually performed in the Day Surgery Unit. You may have either a local or a general anaesthetic depending on your choice and the position of the tumour. Using the cystoscope , the cancer is destroyed applying a small electric current through a wire. A laser may also be used.
You would not normally need to stay overnight in hospital for this type of operation. However, if you have a general anaesthetic you will need collecting from hospital and have someone stay at home with you for the first 24 hours.
Trans Urethral Resection of Bladder Tumour (TURBT)
If you take Aspirin either as regularly or as a pain-killer, I will normally ask you to stop it for ten to fourteen days before the operation.. This is because Aspirin has a blood thinning affect in your body and may cause you to bleed more after the operation.
The operation is again performed using a telescope, and can be performed under general or spinal anaesthetic. A special instrument called a resectoscope is passed into the bladder and the tumour removed at the "stem". The area will then be cauterised using a mild electrical current to prevent excessive bleeding. A biopsy (small sample) of the tumour will be sent to the laboratory for analysis.
When you return from the operating theatre you may have a catheter (plastic tube) which will drain urine from your bladder into a bag. You can expect some bleeding after a TURBT, so you may also have bladder irrigation (a bag of fluid) which will go into your bladder via the catheter and wash any blood and debris into the bag. You may have this for about 24-48 hours, or until the bleeding subsides. The catheter will be removed when your urine becomes clear and then you will be able to pass urine normally.
You may also have an intravenous infusion (a "drip"), which will provide you with fluid directly into your bloodstream. You can expect to start eating and drinking very quickly after this operation and then you will no longer need the "drip". In fact, you will be encouraged to drink plenty of non-alcoholic beverages (up to 3 litres a day) to help to clear the urine. The nurses will record how much you drink and the amount of urine you produce. Once the catheter is removed you can reduce your fluid intake to about 1.5 litres a day.
Sometimes, in the 24 hours after your operation you may have a drug put into your bladder through the catheter. The drug I currently use is Mitomycin C, an anti cancer drug. This may help to reduce the chance of the tumours returning. Given into the bladder it does not have any of the side effects of chemotherapy such as hair loss or vomiting, as only the bladder is treated.
It is unusual to have a lot of pain after a TURBT, and any discomfort that you may experience is usually caused by the catheter irritating the bladder. You may feel this as a bladder spasm, which may cause a small amount of urine to leak around the catheter. Fortunately, this does not last for more than a few seconds, but if it is particularly troublesome please let the nurses know. Sometimes the discomfort will be felt at the tip of the penis and this may be relieved by the application of some local anaesthetic gel. Occasionally, the catheter may become blocked with a blood clot, so that the urine is unable to drain from the bladder. If this does occur a nurse will be able to relieve the blockage by performing a bladder washout.
Once the catheter is removed you may experience pain in your urethra, particularly when passing urine. This pain will usually settle after about 48 hours and can be relieved by maintaining a high fluid intake (1.5 litres a day) to dilute your urine and, if necessary by taking mild pain-killers.
Cysto-diathermy/ Laser ablation
You can expect only minimal discomfort, which may be experienced as pain in your urethra, particularly when passing urine. The pain will usually settle after about 48 hours and can be relieved by maintaining a high fluid intake (1.5 litres a day) to dilute your urine and, if necessary by taking mild pain-killers.
Bleeding is usually minimal. You may notice that your urine is slightly blood-stained when you pass urine on the first couple of occasions after the operation.
You can resume your normal activity very quickly. If you have had a general anaesthetic, you should check with you insurance company before driving again. You may be more susceptible to urine infections for a while, therefore it is a good idea to empty your bladder immediately after intercourse.
Once you get home from hospital, you should continue to drink 1.5 litres a day for the first two weeks. You should avoid constipation as the increased straining to open your bowels may cause increased bleeding. To help prevent this you should eat a high fibre diet (plenty of fruit, vegetables, wholemeal bread and cereals). If this does not improve your constipation, then a mild laxative may be required.
After 7-21 days a scab may form in the bladder and this can be shed into the urine. At this time you may notice a return of slight bleeding. If this does occur you may need to increase your fluid intake.
You should avoid all heavy lifting (such as carrying children or shopping) for the first 2 weeks. Light exercise (such as walking less than a mile) is good for you, but strenuous sports should be avoided for the first month. You should not drive for the first 2 weeks after your operation. Please check with your insurance company regarding policy limitations. After the first 2 weeks you can gradually increase your activity , until you are back to normal after a month. Sexual activity can be resumed when you feel comfortable. You may be more susceptible to urine infections for a while following a TURBT, therefore it is a good idea to empty your bladder immediately after intercourse.
You may start a course of antibiotics in hospital, which should be continued at home if advised. A urine infection may develop after you are discharged from hospital and you may experience one or more of the following symptoms: fever; abdominal pain; cloudy/offensive urine; persistent burning and bleeding. If you do suspect an infection, then you will need to see your GP straight away.
When can I return to work ?
After a TURBT most people can expect to return to work after a couple of weeks, unless you have a very heavy manual job. After Cysto-diathermy/ Laser ablation you can expect to return to work as soon as you feel able.
What follow up is needed?
After a TURBT you will often be seen in the out-patient department in about 2-8 weeks. However, after both a TURBT and cysto-diathermy/ laser ablation you will require regular cystoscopies (bladder inspections) to check that your superficial bladder cancer has not returned. This may be at 3, 6 or 12 monthly intervals and will often continue for the rest of your life. These can often be performed under local anaesthetic (Flexible cystoscopy).
If the tumour is classified as at higher risk of recurrence we may discuss with you the option of further treatments given into the bladder (no anaesthetic is required for this) prior to your first check cystoscopy.
Smoking greatly increases your chances of getting bladder cancer. Therefore, it is a good idea to stop smoking now. This will help to reduce the chances of your superficial bladder cancer returning again.
A diet which contains a lot of fresh fruit and vegetables and the intake of antioxidant vitamins (such as vitamin E) may be of some benefit.
Copyright (c) 1999-2001 GH Muir. All rights reserved.