Surgery for early bladder cancer
Surgery is the main treatment for non-invasive bladder cancer. There is usually one or more small tumours on the bladder lining that can be removed surgically using a cystoscope.
Before your surgery, the urologist and specialist nurse will explain the operation to you. They will tell you what to expect immediately after the surgery and in the few days after it. This is a good opportunity to ask any questions you have about the operation.
It’s important that you discuss the operation fully with your surgeon beforehand so that you understand what it involves. Remember, no operation or procedure will be done without your consent.
You may be admitted to the ward the day before your operation, so that the doctors and nurses can do any further tests. You’ll then have a medical examination, which will include a blood test to check your general health. This is to make sure that you’re fit enough to have a general anaesthetic. Or you may have a pre-operative assessment at an outpatient clinic a few days before the operation.
Some people have the operation done under a spinal anaesthetic. The doctor injects an anaesthetic drug through a needle into the back to numb the nerves from the waist down. Although you’re awake during the operation, you won’t feel anything.
During the operation, the surgeon inserts a cystoscope into your bladder and removes the tumour(s) using instruments that are passed through the cystoscope. They may use a mild electrical current to stop any bleeding (cauterisation).
The operation is called a transurethral resection of a bladder tumour (TURB). Transurethral means through the urethra, which is connected to the bladder.
You’ll be encouraged to get up out of bed and walk around once you feel well enough. This is important to prevent complications such as chest infections, or blood clots forming in your legs. Most people are given chemotherapy into the bladder immediately after surgery.
You will have a thin, flexible tube (a catheter) in your bladder to drain your urine into a bag, but you can walk around with this.
There will be blood in your urine at first. You will be encouraged to drink plenty of fluids to help flush out your bladder, and to reduce the risk of developing a urine infection.
Sometimes, large bags of fluid are connected to the catheter to flush out the bladder until the bleeding clears. This helps prevents blood clots from forming and blocking the urethra.
When your urine looks clear, the catheter will be taken out. This may feel a little uncomfortable but isn’t painful. If your urine is no longer bloodstained, you’ll usually be allowed to go home. This may be 2-3 days after the operation.
Possible risks of surgery
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Removing early bladder cancers is generally a safe procedure. However, as with any operation, there are some possible risks.
Some people may get a urine infection while they are still in hospital or after they go home. Signs of an infection include:
feeling cold, shivery, hot or sweaty
feeling generally unwell
your urine getting smelly or cloudy.
If you think you have an infection, you can take a urine sample to your doctor for testing.
Bleeding that goes on for more than a few days
Up to about 3 in 100 people may need a blood transfusion for this. If the bleeding continues, you may need another operation under general anaesthetic to stop it.
Some people may have bleeding about 10-14 days after the TURB. This usually stops on its own after a couple of days.
Always tell your doctor if you have blood or clots of blood in your urine following your surgery.
Damage to the bladder
There’s a 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 allow the hole to heal. If it doesn’t heal in that time, an operation can be done to seal the hole.
If there’s a risk that some cancer cells may have been left behind, your doctors may want to do another TURB a few weeks after the first operation.
Surgery to remove the bladder (cystectomy)
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This is only very occasionally needed. It’s usually only done after other treatments to control the cancer have been tried.
The aim of a cystectomy is to remove the cancer before it spreads into the muscle layer, and possibly to other parts of the body (secondary or metastatic bladder cancer). When bladder cancer has spread to other parts of the body, it can no longer be cured.
Being advised to have your bladder removed to treat a non-invasive cancer can be hard to accept. Your urologist will carefully weigh up the possible benefits of treatments that aim to keep the bladder, against the risks of the cancer spreading before suggesting a cystectomy.
With support from family, friends, health professionals and support organisations, people usually manage to cope well with a cystectomy.
There’s more information about cystectomy in our section about surgery for invasive or advanced bladder cancer.