Surgery for early bladder cancer

Early bladder cancers are usually small growths (papillary cancers) and there may be more than one. The cancer or cancers can usually be removed surgically, using a cystoscope.

Before surgery Back to top

Before surgery you’ll have a blood test to check your general health. You can also discuss the surgery with a specialist nurse or a doctor. You’ll then have a medical examination to make sure that you’re fit enough to have an anaesthetic.

You’ll be admitted to the surgical ward on the day of surgery, or the day before. The surgeon or anaesthetist will talk to you about your operation and ask you to sign a consent form. A research nurse may ask for your permission to keep blood samples and some of the tissue taken during surgery and use it for future research. If you agree to this, you’ll be asked to sign a second consent form.

The operation Back to top

You’ll be given a general anaesthetic and a cystoscope| will be inserted into your bladder. The tumour is cut out or burnt off (cauterised) using a mild electrical current.

This procedure is known as a transurethral resection of a bladder tumour (TURB). Transurethral means through the fine tube (urethra), which is connected to the bladder. The whole procedure is done in this way and several tumours can be treated at the same time if necessary. You won’t be left with a scar because there’s no wound.

The operation usually takes 20-60 minutes. You may be given chemotherapy| into your bladder immediately after surgery.

After the operation Back to top

When you go back to the ward you’ll have a thin, flexible tube (a catheter) in your bladder, which drains your urine into a bag. It may make you feel as though you want to pass urine.

Your urine will be bloodstained at first. Large bags of fluid may also be used to flush out the bladder continuously. This is to make sure that blood clots don’t form and block the urethra.

Once you are drinking normally and your urine looks clear, the catheter will be taken out. This is not painful but may feel a little uncomfortable. Once the catheter has been removed and your urine is no longer bloodstained, you’ll be allowed to go home. This is usually about 2-3 days after the operation.

Possible risks of surgery Back to top

Removing early bladder cancers is a safe procedure. However, it can have some risks. These are outlined below.

Urine infection

5-10 out of every 100 patients (5-10%) may get a urine infection. This may be while they are still in hospital or after they go home. Signs of an infection include: feeling cold, shivery, hot or sweaty; feeling generally ill; or your urine becoming smelly or cloudy. If you think you have an infection, you can take a urine sample to your doctor for testing.

Bleeding for more than a few days

This occurs in up to 5 out of every 100 patients (5%). Some of these patients may need a blood transfusion. If the bleeding doesn’t stop on its own, you may need another operation under general anaesthetic to stop it.

You may find that you have some further bleeding about 10-14 days after the operation to remove the cancer. This usually stops on its own after a couple of days. If the bleeding lasts for longer than this, or if you can see clots of blood, tell your doctor.

Damage to the bladder

There is a very small risk of a hole (perforation) being made in the bladder during surgery. If this happens it can usually be managed by having a catheter in the bladder for about 7-10 days, to drain the urine and allow the hole to heal. If the hole doesn’t heal in that time, you may need an operation to seal it. This involves making a cut in the abdomen. Your doctor or nurse will explain this procedure if it’s needed.

Further surgery Back to top

If there’s a risk that some cancer cells may have been left behind, your doctors may decide that a second operation is needed. This can happen when:

• the tumour has grown through the bladder lining into the layer of connective tissue (stage T1)
• the tumour is high grade
• the tumour is large or there are several tumours.

The second procedure would normally take place 2-6 weeks after your first operation.

After surgery Back to top

After your operation your doctors will know more about the stage| of your cancer. This information, along with its grade|, helps them decide the most appropriate treatment for you. You may be advised to have further treatment with chemotherapy| or BCG| to reduce the chances of the cancer coming back (recurring) or growing into the muscle (becoming invasive).