Transurethral Bladder Resection

Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives

Definition

Transurethral bladder resection is a surgical procedure used to view the inside of the bladder, remove tissue samples, and/or remove tumors. Instruments are passed through a cystoscope (a slender tube with a lens and a light) that has been inserted through the urethra into the bladder.

Purpose

Transurethral resection is the initial form of treatment for bladder cancers. The procedure is performed to remove and examine bladder tissue and/or a tumor. It may also serve to remove lesions, and it may be the only treatment necessary for noninvasive tumors. This procedure plays both a diagnostic and therapeutic role in the treatment of bladder cancers.

Demographics

Bladder cancer is the sixth most commonly diagnosed malignancy in the United States. According to the American Cancer Society, about 67,160 new cases of bladder cancer were projected to be diagnosed in the United States in 2007.

Industrialized countries such as the United States, Canada, France, Denmark, Italy, and Spain have the highest incidence rates for bladder cancer. Rates are lower in England, Scotland, and Eastern Europe. The lowest rates occur in Asia and South America.

Smoking is a major risk factor for bladder cancer; it increases one’s risk by two to five times and accounts for approximately 50% of bladder cancers found in men and 30% found in women. If cigarette smokers quit, their risk declines in two to four years. Exposure to a variety of industrial chemicals also increases the risk of developing this disease. Occupational exposures may account for approximately 25% of all urinary bladder cancers.

Men have a l-in-30 chance of developing bladder cancer; women have a l-in-90 chance of developing bladder cancer. The incidence of bladder cancer in the white population is almost twice that of the black population. For other ethnic and racial groups in the United States, the incidence of bladder cancer falls between that of whites and blacks.

There is a greater incidence of bladder cancer with advancing age. Of newly diagnosed cases in both men and women, approximately 80% occur in people aged 60 years and older.

Description

Cancer begins in the lining layer of the bladder and grows into the bladder wall. Transitional cells line the inside of the bladder. Cancer can begin in these lining cells.

During transurethral bladder resection, a cystoscope 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. A biopsy is taken of the tumor and muscle fibers 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.

Diagnosis/Preparation

If there is reason to suspect a patient may have bladder cancer, the physician will use one or more methods to determine if the disease is actually present. The doctor first takes a complete medical history to check for risk factors and symptoms, and does a physical examination. An examination of the rectum and vagina (in women) may also be performed to determine the size of a bladder tumor and to see if and how far it has spread. If bladder cancer is suspected, the following tests may be performed, including:

• biopsy
• cystoscopy
• urine cytology
• bladder washings
• urine culture
• intravenous pyelogram

KEY TERMS

Biopsy— The removal and microscopic examination of a small sample of body tissue to see whether cancer cells are present.

Bladder irrigation— To flush or rinse the bladder with a stream of liquid (as in removing a foreign body or medicating).

Bladder washings— A procedure in which bladder washing samples are taken by placing a salt solution into the bladder through a catheter (tube) and then removing the solution for microscopic testing.

Bladder tumor marker studies— A test to detect specific substances released by bladder cancer cells into the urine using chemical or immunologic (using antibodies).

Chemotherapy— The treatment of cancer with anticancer drugs.

Cystoscopy— A procedure in which a slender tube with a lens and a light is placed into the bladder to view the inside of the bladder and remove tissue samples.

Immunotherapy— A method of treating allergies in which small doses of substances that a person is allergic to are injected under the skin.

Interstitial radiation therapy— The process of placing radioactive sources directly into the tumor. These radioactive sources can be temporary (removed after the proper dose is reached) or permanent.

Intravenous pyelogram— An x ray of the urinary system after injecting a contrast solution that enables the doctor to see images of the kidneys, ureters, and bladder.

Metastatic— A change of position, state, or form; as a transfer of a disease-producing agency from the site of disease to another part of the body; a secondary growth of a cancerous tumor.

Noninvasive tumors— Tumors that have not penetrated the muscle wall and/or spread to other parts of the body.

Radiation therapy— The use of high-dose x rays to destroy cancer cells.

Retrograde pyelography— A test in which dye is injected through a catheter placed with a cystoscope into the ureter to make the lining of the bladder, ureters, and kidneys easier to see on x rays.

Urine culture— A test which tests urine samples in the lab to see if bacteria are present.

Ureters— Two thin tubes that carry urine downward from the kidneys to the bladder.

Urethra— The small tube-like structure that allows urine to empty from the bladder.

Urine cytology— The examination of the urine under a microscope to look for cancerous or precancerous cells.

• retrograde pyelography
• bladder tumor marker studies

Most of the time, the cancer begins as a superficial tumor in the bladder. Blood in the urine is the usual warning sign. Based on how they look under the microscope, bladder cancers are graded using Roman numerals 0 through IV. In general, the lower the number, the less the cancer has spread. A higher number indicates greater severity of cancer.

Because it is not unusual for people with one bladder tumor to develop additional cancers in other areas of the bladder or elsewhere in the urinary system, the doctor may biopsy several different areas of the bladder lining. If the cancer is suspected to have spread to other organs in the body, further tests will be performed.

Because different types of bladder cancer respond differently to treatment, the treatment for one patient could be different from that of another person with bladder cancer. Doctors determine how deeply the cancer has spread into the layers of the bladder in order to decide on the best treatment.

Aftercare

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 (cystoscope) at regular intervals. Because bladder cancer has a high rate of recurrence, frequent screenings are recommended. Normally, screenings would be needed every three to six months for the first three years, and every year after that, or as the physician considers necessary. Cystoscopy can catch a recurrence before it progresses to invasive cancer, which is difficult to treat.

Risks

All surgery carries some risk due to heart and lung problems or the anesthesia itself, but these risks are generally extremely small. The risk of death from general anesthesia for all types of surgery, for example, is only about one in 1,600. Bleeding and infection are other risks of any surgical procedure. If bleeding becomes a complication, bladder irrigation may be required postoperatively, during which time the patient’s activity is limited to bed rest. 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.

Normal results

The results of transurethral bladder resection will depend on many factors, including the type of treatment used, the stage of the patient’s cancer before surgery, complications during and after surgery, the age and overall health of the patient, as well as the recurrence of the disease at a later date. The chances for survival are improved if the cancer is found and treated early.

Morbidity and mortality rates

After a diagnosis of bladder cancer, up to 95% of patients with superficial tumors survive for at least five years. Patients whose cancer has grown into the lining of the bladder but not into the muscle itself, and is not in any lymph nodes or distant sites, have a five year survival rate as high as 85%. The five-year survival rate may be as high as 55% for patients whose tumors have invaded the bladder muscle, but not spread through the muscle into the surrounding fatty tissue. When the cancer has grown totally through the bladder muscle into the surrounding fatty tissue, and perhaps into nearby tissues such as the prostate, uterus, or vagina, the five-year survival rate is about 38%. For patients whose cancer has spread through the bladder wall to the pelvis or abdominal wall or has spread distantly to lymph nodes or other organs (such as the bones, liver, or lungs), the five-year survival rate is 16%.

The five-year survival rate refers to the percentage of patients who live at least five years after their cancer is found, although many people live much longer. Five-year relative survival rates do not take into account patients who die of other diseases. Every person’s situation is unique and the statistics cannot

WHO PERFORMS THIS PROCEDURE AND WHERE IS IT PERFORMED?

Transurethral bladder resections are usually performed in a hospital by a urologist, a medical doctor who specializes in the diagnosis and treatment of diseases of the urinary systems in men and women and also treats structural problems and tumors or stones in the urinary system. Urologists can prescribe medications and perform surgery. If a transurethral bladder resection is required by a female patient, and there are complicating factors, an urogynecologist may perform the surgery. Uro-gynecologists treat urinary problems involving the female reproductive system.

predict exactly what will happen in every case; these numbers provide an overall picture.

Mortality rates are two to three times higher for men than women. Although the incidence of bladder cancer in the white population exceeds those of the black population, black women die from the disease at a greater rate. This is due to a larger proportion of these cancers being diagnosed and treated at an earlier stage in the white population. The mortality rates for Hispanic and Asian men and women are only about one-half those for whites and blacks. Over the past 30 years, the age-adjusted mortality rate has decreased in both races and genders. This may be due to earlier diagnosis, better therapy, or both.

About 67,160 cases of bladder cancer were projected to be diagnosed in 2007 in the United States. There are over 500,000 bladder cancer survivors in the United States, and approximately 13,750 will die of the disease in 2007.

Alternatives

Surgery, radiation therapy, immunotherapy, and chemotherapy are the main types of treatment for cancer of the bladder. One type of treatment or a combination of these treatments may be recommended, based on the stage of the cancer.

After the cancer is found and staged, the cancer care team discusses the treatment options with the patient. In choosing a treatment plan, the most significant factors to consider are the type and stage of the cancer. Other factors to consider include the patient’s overall physical health, age, likely side effects of the treatment, and the personal preferences of the patient.

QUESTIONS TO ASK THE DOCTOR

• What benefits can I expect from this operation?
• What are the risks of this operation?
• What are the normal results of this operation?
• What happens if this operation does not go as planned?
• Are there any alternatives to this surgery?
• What is the expected recovery time?

In considering treatment options, a second opinion may provide more information and help the patient feel more confident about the treatment plan chosen.

Alternative methods are defined as unproved or disproved methods, rather than evidence-based or pro-en methods to prevent, diagnose, and treat cancer. For some cancer patients, conventional treatment is difficult to tolerate and they may decide to seek a less unpleasant alternative. Others are seeking ways to alleviate the side effects of conventional treatment without having to take more drugs. Some do not trust traditional medicine, and feel that with alternative medicine approaches, they are more in control of making decisions about what is happening to their bodies.

A cancer patient should talk to the doctor or nurse before changing the treatment or adding any alternative methods. Some methods can be safely used along with standard medical treatment. Others may interfere with standard treatment or cause serious side effects.

The American Cancer Society (ACS) encourages people with cancer to consider using methods that have been proven effective or those that are currently under study. They encourage people to discuss all treatments they may be considering with their physician and other health care providers. The ACS acknowledges that more research is needed regarding the safety and effectiveness of many alternative methods. Unnecessary delays and interruptions in standard therapies could be detrimental to the success of cancer treatment.

At the same time, the ACS acknowledges that certain complementary methods such as aromatherapy, biofeedback, massage therapy, meditation, tai chi, or yoga may be very helpful when used in conjunction with conventional treatment.

Resources

BOOKS

Hicks, M. Bladder Cancer, Cambridge, UK: Cambridge University Press, 2004.

Miller, R. D. Miller’s Anesthesia, 6th ed. Philadelphia: Elsevier, 2005.

Wein, A. J., et al. Campbell-Walsh Urology, 9th ed. Philadelphia: Saunders, 2007.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org (accessed April 12, 2008).

American Foundation for Urologic Disease. 1128 North Charles St., Baltimore, MD 21201. (410) 468-1800. (800) 242-2383. Fax: (410) 468-1808. E-Mail: [email protected]. http://www.afud.org/ (accessed April 12,2008).

National Cancer Institute Public Inquiries Office. Suite 3036A. 6116 Executive Boulevard, MSC8322. Bethesda, MD 20892-8322. (800) 422-6237. http://www.nci.nih.gov (accessed April 12, 2008).

National Comprehensive Cancer Network. 50 Huntingdon Pike, Suite 200, Rockledge PA 19046. (215) 728-4788. Fax: (215) 728-3877. Email: [email protected]. http://www.nccn.org/ (accessed April 12, 2008).

National Institutes of Health (NIH), Department of Health and Human Services. 9000 Rockville Pike. Bethesda, MD 20892.

OTHER

Aetna InteliHealth Inc. Bladder Cancer, 2003 [cited April 24, 2003]. http://www.intelihealth.com/IH/ihtIH?t=31066&p=∼br,IHW|~st,24479|~r,WSIHW000|~b,*| (accssed April 12, 2008).

American Cancer Society, Inc. (ACS) Cancer Reference Information, 2003 [cited April 24, 2003]. http://www.cancer.org/cancerinfo (accessed April 12, 2008).

Kathleen D. Wright, RN

Crystal H. Kaczkowski, MSc

Rosalyn Carson-DeWitt, MD

Transurethral bladder resection

Definition

Transurethral bladder resection is a surgical procedure used to view the inside of the bladder, remove tissue samples, and/or remove tumors. Instruments are passed through a cystoscope (a slender tube with a lens and a light) that has been inserted through the urethra into the bladder.

Purpose

Transurethral resection is the initial form of treatment for bladder cancers. The procedure is performed to remove and examine bladder tissue and/or a tumor. It may also serve to remove lesions, and it may be the only treatment necessary for noninvasive tumors. This procedure plays both a diagnostic and therapeutic role in the treatment of bladder cancers.

Demographics

Bladder cancer is the sixth most commonly diagnosed malignancy in the United States. According to the American Cancer Society, about 57,400 new cases of bladder cancer will be diagnosed in the United States in 2003.

Industrialized countries such as the United States, Canada, France, Denmark, Italy, and Spain have the highest incidence rates for bladder cancer. Rates are lower in England, Scotland, and Eastern Europe. The lowest rates occur in Asia and South America.

Smoking is a major risk factor for bladder cancer; it increases one's risk by two to five times and accounts for approximately 50% of bladder cancers found in men and 30% found in women. If cigarette smokers quit, their risk declines in two to four years. Exposure to a variety of industrial chemicals also increases the risk of developing this disease. Occupational exposures may account for approximately 25% of all urinary bladder cancers.

The incidence of bladder cancer in the white population is almost twice that of the black population, and is more than 2.5 times more likely to be diagnosed in men than women. For other ethnic and racial groups in the United States, the incidence of bladder cancer falls between that of whites and blacks.

There is a greater incidence of bladder cancer with advancing age. Of newly diagnosed cases in both men and women, approximately 80% occur in people aged 60 years and older.

Description

Cancer begins in the lining layer of the bladder and grows into the bladder wall. Transitional cells line the inside of the bladder. Cancer can begin in these lining cells.

During transurethral bladder resection, a cystoscope 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. A biopsy is taken of the tumor and muscle fibers 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.

Diagnosis/Preparation

If there is reason to suspect a patient may have bladder cancer, the physician will use one or more methods to determine if the disease is actually present. The doctor first takes a complete medical history to check for risk factors and symptoms, and does a physical examination . An examination of the rectum and vagina (in women) may also be performed to determine the size of a bladder tumor and to see if, and how far, it has spread. If bladder cancer is suspected, the following tests may be performed:

• biopsy
• cystoscopy
• urine cytology
• bladder washings
• urine culture
• intravenous pyelogram
• retrograde pyelography
• bladder tumor marker studies

Most of the time, the cancer begins as a superficial tumor in the bladder. Blood in the urine is the usual warning sign. Based on how they look under the microscope, bladder cancers are graded using Roman numerals 0 through IV. In general, the lower the number, the less the cancer has spread. A higher number indicates greater severity of cancer.

Because it is not unusual for people with one bladder tumor to develop additional cancers in other areas of the bladder or elsewhere in the urinary system, the doctor may biopsy several different areas of the bladder lining. If the cancer is suspected to have spread to other organs in the body, further tests will be performed.

Because different types of bladder cancer respond differently to treatment, the treatment for one patient could be different from that of another person with bladder cancer. Doctors determine how deeply the cancer has spread into the layers of the bladder in order to decide on the best treatment.

Standard with any surgical procedure, the patient is asked to sign a consent form after a thorough explanation of the planned procedure.

Aftercare

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 (cystoscope) at regular intervals. Because bladder cancer has a high rate of recurrence, frequent screenings are recommended. Normally, screenings would be needed every three to six months for the first three years, and every year after that, or as the physician considers necessary. Cystoscopy can catch a recurrence before it progresses to invasive cancer, which is difficult to treat.

Risks

All surgery carries some risk due to heart and lung problems or the anesthesia itself, but these risks are generally extremely small. The risk of death from general anesthesia for all types of surgery, for example, is only about one in 1,600. Bleeding and infection are other risks of any surgical procedure. If bleeding becomes a complication, bladder irrigation may be required postoperatively, during which time the patient's activity is limited to bed rest. 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.

Normal results

The results of transurethral bladder resection will depend on many factors, including the type of treatment used, the stage of the patient's cancer before surgery, complications during and after surgery, the age and overall health of the patient, as well as the recurrence of the disease at a later date. The chances for survival are improved if the cancer is found and treated early.

Morbidity and mortality rates

After a diagnosis of bladder cancer, up to 80% of patients with superficial tumors survive for at least five years. The five-year survival rate may be as high as 75% for patients whose tumors have invaded the bladder muscle. The five-year survival rates are 40% or less for patients with more-invasive tumors or metastatic tumors. The five-year survival rate refers to the percentage of patients who live at least five years after their cancer is found, although many people live much longer. Five-year relative survival rates do not take into account patients who die of other diseases. Every person's situation is unique and the statistics cannot predict exactly what will happen in every case; these numbers provide an overall picture.

Mortality rates are two to three times higher for men than women. Although the incidence of bladder cancer in the white population exceeds those of the black population, black women die from the disease at a greater rate. This is due to a larger proportion of these cancers being diagnosed and treated at an earlier stage in the white population. The mortality rates for Hispanic and Asian men and women are only about one-half those for whites and blacks. Over the past 30 years, the age-adjusted mortality rate has decreased in both races and genders. This may be due to earlier diagnosis, better therapy, or both.

Of the 57,400 cases of bladder cancer diagnosed each year in the United States, approximately 12,500 will die.

Alternatives

Surgery, radiation therapy, immunotherapy, and chemotherapy are the main types of treatment for cancer of the bladder. One type of treatment or a combination of these treatments may be recommended, based on the stage of the cancer.

After the cancer is found and staged, the cancer care team discusses the treatment options with the patient. In choosing a treatment plan, the most significant factors to consider are the type and stage of the cancer. Other factors to consider include the patient's overall physical health, age, likely side effects of the treatment, and the personal preferences of the patient.

In considering treatment options, a second opinion may provide more information and help the patient feel more confident about the treatment plan chosen.

Alternative methods are defined as unproved or disproved methods, rather than evidence-based or proven methods to prevent, diagnose, and treat cancer. For some cancer patients, conventional treatment is difficult to tolerate and they may decide to seek a less unpleasant alternative. Others are seeking ways to alleviate the side effects of conventional treatment without having to take more drugs. Some do not trust traditional medicine, and feel that with alternative medicine approaches, they are more in control of making decisions about what is happening to their bodies.

A cancer patient should talk to the doctor or nurse before changing the treatment or adding any alternative methods. Some methods can be safely used along with standard medical treatment. Others may interfere with standard treatment or cause serious side effects.

The American Cancer Society (ACS) encourages people with cancer to consider using methods that have been proven effective or those that are currently under study. They encourage people to discuss all treatments they may be considering with their physician and other health care providers. The ACS acknowledges that more research is needed regarding the safety and effectiveness of many alternative methods. Unnecessary delays and interruptions in standard therapies could be detrimental to the success of cancer treatment.

At the same time, the ACS acknowledges that certain complementary methods such as aromatherapy, biofeedback, massage therapy, meditation, tai chi, or yoga may be very helpful when used in conjunction with conventional treatment.

Resources

books

Hanno, Philip M., S. Bruce Malkowicz, and Alan J. Wein, (editors). Clinical Manual of Urology, 3rd ed. Philadelphia: McGraw-Hill, Inc., 2001.

Hicks, M. Bladder Cancer. Cambridge, UK: Cambridge University Press, 2004.

Schoenberg, Mark P. The Guide to Living with Bladder Cancer. Baltimore, MA: Johns Hopkins University Press, 2001.

periodicals

Bach, Peter B., Deborah Schrag, Otis W. Brawley, Aaron Galaznik, Sofia Yakren, and Colin B. Begg. "Survival of Blacks and Whites after a Cancer Diagnosis." Journal of American Medical Association 285 (2001): 324–328.

Smith, Shannon D., Marcia A. Wheeler, Janet Plescia, John W. Colberg, Robert M. Weiss, and Dario C. Altieri. "Urine Detection of Surviving and Diagnosis of Bladder Cancer." Journal of American Medical Association 285 (2001): 324–328.

organizations

American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329-4251. (800) 227-2345. <http://www.cancer.org>.

American Foundation for Urologic Disease. 1128 North Charles St., Baltimore, MD 21201. (410) 468-1800. (800) 242-2383. Fax: (410) 468-1808. E-Mail: <admin@afud. org>. <http://www.afud.org/>.

National Cancer Institute Public Inquiries Office. Suite 3036A. 6116 Executive Boulevard, MSC8322. Bethesda, MD 20892-8322. (800) 422-6237. <http://www.nci.nih.gov>.

National Comprehensive Cancer Network. 50 Huntingdon Pike, Suite 200, Rockledge PA 19046. (215) 728-4788. Fax: (215) 728-3877. Email: <[email protected]>. <http://www.nccn.org/>.

National Institutes of Health (NIH), Department of Health and Human Services. 9000 Rockville Pike. Bethesda, MD 20892.

other

Aetna InteliHealth Inc. Bladder Cancer, 2003 [cited April 24, 2003] <http://www.intelihealth.com/>.

American Cancer Society, Inc. (ACS) Cancer Refererence Information, 2003 [cited April 24, 2003] <http://www3.cancer.org/cancerinfo>.

Kathleen D. Wright, RN Crystal H. Kaczkowski, MSc

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Transurethral bladder resections are usually performed in a hospital by a urologist, a medical doctor who specializes in the diagnosis and treatment of diseases of the urinary systems in men and women, and treats structural problems and tumors or stones in the urinary system. Urologists can prescribe medications and perform surgery. If a transurethral bladder resection is required by a female patient, and there are complicating factors, a urogynecologist may perform the surgery. Urogynecologists treat urinary problems involving the female reproductive system.

QUESTIONS TO ASK THE DOCTOR

• What benefits can I expect from this operation?
• What are the risks of this operation?
• What are the normal results of this operation?
• What happens if this operation does not go as planned?
• Are there any alternatives to this surgery?
• What is the expected recovery time?

Transurethral Bladder Resection

Definition

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.

Purpose

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.

Description

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.

Preparation

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.

Aftercare

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 (cystoscope) at regular intervals as the physician deems necessary.

Abnormal results

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.

Resources

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. 〈http://www.cancer.org〉.

National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. (800) 422-6237. 〈http://www.nci.nih.gov〉.