TUR-T Surgery in Bladder Cancer

TUR-T, that is transurethral resection of bladder cancer, is a surgical procedure performed both to make a diagnosis in early-stage bladder cancers and with the aim of treating superficial bladder cancers.

When a suspicious area or a mass is detected in the bladder during ultrasonography or cystoscopy (endoscopy), we cut this mass/area with the procedure we call TUR-T and send it to pathology. If this mass does not cover a very wide area within the bladder, generally all of the mass is cut and its base is scraped. In this way we both understand whether the mass is a tumour and, if this mass is a superficial cancer, we have carried out its treatment.   

Bladder cancer is seen 4 times more in men than in women. This situation is explained by the rate of heavy smoking being higher in men and by exposure to chemical substances as workers being greater in men.

In 4 out of 5 patients diagnosed with bladder cancer the cancer is caught at an early stage. Early-stage bladder cancers are also called "superficial bladder cancer" or "non-muscle-invasive bladder cancer". In early-stage (superficial) bladder cancers, metastasis to other parts of the body is generally not seen.

The treatment of superficial bladder cancers is TUR-T surgery. Bladder cancers can recur. As long as these recurrences are superficial, that is do not invade the muscle layer, the cancer is treated with repeated TUR-T operations.

What Is a Bladder Tumour Biopsy? What Is Its Difference From TUR-T?

Both bladder tumour biopsy and TUR-T are procedures performed by entering the bladder through the voiding channel. A bladder tumour biopsy is generally performed using a forceps-like instrument; a piece is torn from the suspicious area with this instrument and the piece is sent to pathology. With a bladder tumour biopsy the whole of the suspicious area is not cleared and its root is not scraped. A bladder tumour biopsy is a procedure that can be performed without anaesthesia being given. A bladder tumour biopsy is a procedure performed only to make a diagnosis.

TUR-T is performed under anaesthesia. The tumour-bearing area in the patient's bladder is cut with electrical energy or laser and completely removed. The base of the tumour is also scraped and sent to pathology. With TUR-T a diagnosis is both made and the tumour-bearing area is completely cleared.    

Things That Need to Be Done Before TUR-T Surgery

Normally fluid intake and eating need to be stopped 6 hours before the operation. If your operation is in the morning, stop eating and drinking after 12 the night before the operation. If your operation is in the afternoon, have a light breakfast at around 6 a.m. and after that you can stop eating and drinking.

If you have medicines you need to take regularly such as blood pressure medicine; you can take your medicine with one or two sips of water. Talk with your physician about which medicine needs to be used before the operation and organise it. The taking of blood-thinning medicines is generally stopped 5-7 days before TUR-T surgery. Your cardiologist decides whether or not short-acting blood-thinning injections are to be given in place of the discontinued medicines.

You may not be able to shower for 1-2 days after the operation, so I recommend that you take a warm shower before the operation. Do not apply any deodorant or perfume after the shower.

When coming to hospital for the operation, either come by taxi or have a relative bring you to hospital in their car. Because you have had anaesthesia, I do not recommend that you return home by driving after the operation.

How Is a Bladder Tumour Biopsy or TUR-T Applied?

This operation is generally performed under general anaesthesia, that is with you asleep. Sometimes patients or physicians may prefer regional anaesthesia (spinal anaesthesia) with numbing from the waist. In this situation the patient is awake but feels nothing. Giving general anaesthesia in the treatment of tumours of the lateral wall of the bladder reduces the possibility of bladder injury in the patient due to obturator reflexes.

Your urology specialist reaches the bladder by entering through your voiding channel with a special device called a resectoscope. The instrument called a resectoscope is a rigid, straight instrument approximately 1 cm thick. Because the TUR-T procedure is performed by entering through the voiding channel, there is no need for an additional incision to perform the operation, that is it is an endoscopic operation.

Fluid is sent into the bladder through one channel inside the resectoscope instrument, while through the other channel the fluid inside the bladder is drained out. In this way continuous irrigation is carried out inside the bladder and a good image is provided. Even if there is bleeding during the cutting of the tumour, thanks to this system the bleeding is easily brought under control without the image being lost.

The tumour seen in the bladder is cut with the energy attached to the resectoscope. Today bipolar energy and laser energy are most often preferred for cutting tumours.

When cutting the tumour-bearing area, the tumour-bearing structure and the base of the tumour are sent for pathological examination as separate pieces. In this way the pathologist's work is made easier and a more accurate diagnosis is enabled. If there are red areas inside the bladder outside the tumour-bearing area, it is necessary to scrape from those points too and send these pieces for examination in separate pathology containers.

After the scrapings have been done with the resectoscope, the resected (scraped) areas are cauterised with electrical or laser energy. In this way the possibility of bleeding after the operation is minimised.

What Are the Complications of TUR-T Surgery?

TUR-T surgery is a technically not very difficult, generally safe procedure. Nevertheless, as in every operation, there are certain risks that can be experienced during or after the operation. The urology specialist who will perform your operation being experienced in this subject, the instruments used working without problems and the procedure being performed with bipolar energy or laser minimise the risk of complications that may occur during the operation.

In TUR-T operations;

• Complications due to anaesthesia
• Urinary tract infection
• Prolonged bladder bleeding
• Tearing or perforation of the bladder
• The development of narrowing in the urinary tract (urethra)

may be seen.

Recovery Time

At the end of the operation a three-way catheter is fitted into your bladder.  While serum fluid is sent into the bladder through one way of the catheter, through another channel of the catheter the urine inside the bladder is taken out. In this way the blood seeping from the cut sites at the end of the operation is prevented from forming a blood clot inside the bladder.

You can start fluid intake 4 hours after the operation and eating 6 hours after. 6 hours after the operation, get up and start moving about.

If bladder cancer is strongly suspected in a person who has had a bladder tumour biopsy or TUR-T, within the first 24 hours after the operation an irrigation with chemotherapy is carried out into the bladder through the catheter. This chemotherapy given into the bladder reduces the risk of the bladder cancer recurring.

The catheter is generally removed 1 day after the operation. If the areas cut inside the bladder are extensive or deep scrapings have been made, the time for the catheter to be withdrawn can extend to up to 3 days.

Patients generally stay in hospital for 1 day. If the patient's bleeding has not stopped, the length of hospital stay and the time of removal of the catheter may be extended.

After the operation the patient's urine may come out bloody for a while. Patients may go to the toilet frequently after the catheter is withdrawn. Patients taking in plenty of fluid after the operation is important in terms of a clot not forming inside the bladder and infection not developing.

After you return home you can go back to your daily life and your work within 2-3 days.

The Treatment Process After TUR-T Surgery

In bladder cancers the tumours generally form again. For this reason patients with bladder cancer are followed with cystoscopic check-ups at frequent intervals. If the cancer in the bladder recurs, it is important that this cancer be treated at an early stage again with TUR-T or bladder tumour resection. 

In order to prevent the recurrence of bladder cancers and to prevent the cancer from reaching deeper tissues, chemotherapy medicines or BCG (the tuberculosis microbe) are given into the bladder at regular intervals after the operation.

When recurrent tumours are detected at an early stage their treatment is easier and the results are gratifying. For this reason patients who have had TUR-T are checked with cystoscopy every 3 months.

TUR-T surgery can be performed on a patient more than once. Repeated TUR-T operations do not bring any additional risk to the patient.

If, as a result of bladder tumour resection with TUR-T, the pathology comes back as a tumour involving (invading) the muscles, then for the patient

• Bladder removal surgery (radical cystectomy)
• Chemotherapy
• Radiotherapy

may be recommended.