During a TURBT, the surgeon inserts a thin tube with a camera and light on the end (cystoscope) into the bladder through the urethra. They remove the tumour (or tumours) using surgical instruments that are passed through the cystoscope. The surgeon may use a mild electrical current (cauterisation) to stop any bleeding.
Sometimes, blue-light cystoscopy or narrow-band imaging are used during surgery to help your doctor remove the tumour (or tumours). Blue-light cystoscopy is also called photodynamic diagnosis (PDD).
The surgeon sends the tumour (or tumours) they have removed to a laboratory to be looked at under a microscope. This tells your doctor more about the stage and grade of the cancer.
You may have another TURBT 2 to 6 weeks after the first one. Your doctor may recommend this if:
- you have a high-risk, non-muscle-invasive bladder cancer – this is to make sure all of the tumour has been removed
- samples taken during your first operation did not contain cells from the bladder muscle layer – this is to check the cancer has not started to spread into the muscle.
When the results of your operation are ready, your doctor will tell you if you need a further operation.
Removing non-muscle-invasive bladder cancer is usually a safe procedure. However, there are some possible risks.
Some people may get a urine infection. This can happen in hospital or after you go home. Signs of an infection include:
- feeling cold, shivery, hot or sweaty
- feeling generally unwell
- smelly or cloudy urine.
Tell your doctor if you think you have a urine infection. They can test your urine and give you antibiotics if you need them.
Some people may have bleeding for about 10 to 14 days after the operation. Tell your doctor or specialist nurse straight away if:
- the bleeding becomes heavier
- you see any blood clots in your urine or on toilet paper
- you have difficulty passing urine
- you have severe tummy pain.
If the bleeding continues, you may need another operation under general anaesthetic to stop it.
Damage to the bladder
There is a small risk of a hole (perforation) being made in the bladder during surgery. If this happens, the catheter is left in the bladder to allow the hole to heal. The catheter will be removed when the hole has healed. Rarely, you may have an operation to close the hole.
Before your operation, you will be seen at a pre-assessment clinic. You may have tests to check your general health. These can include:
The nurse or doctor may ask you for a sample of your urine (pee) to check for any infection. If you have a urine infection, your doctor will give you antibiotics to treat it before surgery.
You will see a member of the surgical team and a specialist nurse who will talk to you about the operation. This is a good time to ask any questions, or to talk about any worries you may have.
You usually go into hospital on the day of your operation. You usually have a general anaesthetic. But you may have the operation done under a spinal anaesthetic. For a spinal anaesthetic, the doctor injects a drug through a needle into your back. This numbs the nerves from the waist down. You will be awake during the operation, but you will not feel anything. If you are having a spinal anaesthetic, you may also have another drug to help you relax.
You will see the doctor who gives you the anaesthetic (the anaesthetist) either at a pre-assessment clinic, or when you are admitted to hospital.
The nurse will talk to you about what you should do before the operation. This can include instructions about medications or eating and drinking.
After your operation, the nurses will encourage you to start moving about as soon as possible. This helps to prevent problems such as chest infections or blood clots.
They will encourage you to do regular leg movements and deep breathing exercises. A physiotherapist or nurse can explain these to you. You will be given elastic stockings (TED stockings) to wear during the operation and for some time afterwards. This is to prevent blood clots in your legs.
Most people are given chemotherapy into the bladder straight after surgery.
You will usually have a tube (catheter) to drain urine from your bladder into a collecting bag.
You will see blood in your urine at first. This is common and your nurse will monitor it. Drinking fluids will help to flush out your bladder and reduce the risk of getting a urine infection.
Sometimes, large bags of fluid are connected to the catheter. This helps to flush out the bladder and stop blood clots forming.
If you feel your bladder is full, or if the catheter stops draining, tell your nurse straight away.
Your nurse will take the catheter out when your urine looks less bloodstained. This may feel a little uncomfortable, but it should not be painful. You may find it uncomfortable to pass urine at first, but this will get better. After the nurse removes the catheter, you might:
- need to pass urine more often
- need to pass urine urgently
- leak urine
- have some blood in your urine
- find it uncomfortable to pass urine.
These symptoms usually get better in 1 to 2 days. But they may continue for several weeks. Tell your doctor if they do not get better. Drinking at least 2 litres (3 ½ pints) of fluid every day can help to reduce these symptoms.
You can usually go home when you can pass urine without the catheter. This may be 1 to 3 days after the operation.
Some people may notice blood in their urine about 10 to 14 days after the surgery. If this bleeding is very heavy, or if you pass blood clots, tell your nurse or doctor straight away.
Everyone recovers from the operation in their own time. When you are at home, it is important to follow the advice given by your specialist nurse. You may need to avoid lifting or carrying anything heavy for 2 to 3 weeks. You can try to do some light exercise, such as walking. This can help to build up your energy, so you can slowly get back to your normal activities.
If you work, your doctor or nurse can give you advice about when to go back.