Transurethral Resection (TUR) for Bladder Cancer
Transurethral Resection (TUR) for Bladder Cancer
Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor). General anesthesia or spinal anesthesia is often used.
During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.
Bladder cancer can come back after this surgery, so repeat TURs are sometimes needed.
What To Expect After Surgery
Following surgery, a catheter may be placed in the urethra to help stop bleeding and to prevent blockage of the urethra. When the bleeding has stopped, the catheter is removed. You may need to stay in the hospital 1 to 4 days.
You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 2 to 3 weeks following surgery.
You may be instructed to avoid strenuous activity for about 3 weeks following TUR.
Why It Is Done
TUR can be used to diagnose, stage, and treat bladder cancer.
- Diagnosis. TUR is used to examine the inside of the bladder to see whether there are cancer cells in the bladder.
- Staging. TUR can determine whether cancers are growing into the bladder wall.
- Treatment. One or more small tumors can be removed from inside the bladder during TUR.
How Well It Works
TUR is the most common and effective treatment for early-stage bladder cancer. It may also be effective for more advanced cancer if all the cancer is removed and biopsies show that no cancer cells remain.
Risks
The risks of TUR include:
- Bleeding.
- Bladder infection (cystitis).
- Perforation of the wall of the bladder.
- Blood in the urine (hematuria).
- Blockage of the urethra by blood clots in the bladder.
What To Think About
Treatment with TUR may be followed by chemotherapy or immunotherapy.
Credit: By Healthwise Staff – WebMD
Holmium Laser Enucleation Of The Prostate
Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to the standard Transurethral Resection of the Prostate (TURP) procedure for bladder outflow obstruction due to BPH. It requires a short period of hospitalisation and an anaesthetic. A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.
Who is it suitable for?
HoLEP can be performed on men of any age with urinary outflow obstruction caused by an enlarged prostate. It is particularly indicated in men with large prostates (over 60mls in size) and men on medications to thin the blood such as warfarin, aspirin or clopidogrel.
What are the advantages of HoLEP
There is no upper size limit of prostate that can be dis-obstructed – traditionally men with prostates over 100ml in size needed major open surgery
- There is often less bleeding than after a TURP
- Discharge is often quicker than after TURP at 1-2 days
- The chance of recurrence requiring further surgery is very low
- Unlike greenlight laser operations, large quantities of prostate tissue are sent for pathological analysis
- The PSA generally drops to very low levels after HoLEP operations
How does it work?
The aim of HoLEP is to relieve pressure on the tube through which the urine drains (urethra) by anatomically enucleating the majority of excess benign prostate tissue. This is done under a general anaesthetic with the help of a telescopic camera inserted through the penis. The three lobes of the prostate that are cored out intact are pushed into the bladder before being sucked up (morcellated) by a special instrument inserted through the telescopic camera. The pieces are sent for laboratory analysis just in case they might be found to be cancerous. A catheter is placed into the bladder to drain the urine while the raw surface heals, then left in place for around 24 hours before being removed on the day of discharge from hospital. Sterile saline fluid is also irrigated into the bladder through the catheter to dilute any blood in the urine and prevent clots from forming.
It is normal to have some blood in the urine after this operation, so it is advisable to drink plenty of water for a few days while it clears. Clots are sometimes passed 10-14 days afterwards; again, this is part of the healing process.
Apart from this and the risk of infection that accompanies any operation or invasive procedure, the only significant side-effect is the near certainty that normal ejaculation will cease. This is because the contraction that occurs during orgasm may not completely block the entrance to the bladder once some tissue has been removed, and the semen will flow back into the bladder (“retrograde” or “dry” ejaculation) rather than out through the penis. This is not harmful, but it does mean that future fertility is greatly reduced. The procedure does not generally affect erectile function or continence, although the urinary symptoms may take a few weeks to settle down afterwards.
Credit: The Prostate Centre
Transurethral Resection of the Prostate (TURP)
What is a transurethral resection of the prostate or TURP?
A transurethral resection of the prostate (TURP) is a surgical procedure that removes portions of the prostate gland through the penis. A TURP requires no external incision.
The surgeon reaches the prostate by inserting an instrument through the urethra (the narrow channel through which urine passes from the bladder out of the body). This instrument, called a resectoscope, is about 12 inches long and one-half inch in diameter. It contains a light, valves that control irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. It’s inserted through the penis and the wire loop is guided by the surgeon so it can remove the obstructing tissue one piece at a time. The pieces of tissue are carried by fluid into the bladder and flushed out at the end of the procedure.
Many common problems are associated with the prostate gland. These problems may occur in men of all ages and include:
- Benign prostatic hyperplasia (BPH). An age-related enlargement of the prostate that isn’t malignant. BPH is the most common noncancerous prostate problem, occurring in most men by the time they reach their 60s. Symptoms are slow, interrupted, or weak urinary stream; urgency with leaking or dribbling; and frequent urination, especially at night. Although it isn’t cancer, BPH symptoms are often similar to those of prostate cancer.
- Prostatism. This involves decreased urinary force due to obstruction of flow through the prostate gland. The most common cause of prostatism is BPH.
- Prostatitis. Prostatitis is inflammation or infection of the prostate gland characterized by discomfort, pain, frequent or infrequent urination, and sometimes fever.
- Prostatalgia. This involves pain in the prostate gland, also called prostatodynia. It’s frequently a symptom of prostatitis.
Cancer of the prostate is a common and serious health concern. According to the American Cancer Society, prostate cancer is the most common form of cancer in men older than age 50, and the third leading cause of death from cancer.
There are different ways to achieve the goal of removing the prostate gland. Methods of performing prostatectomy include:
- Surgical removal includes a radical prostatectomy (RP), with either a retropubic or perineal approach. This is used to treat cancer. Radical prostatectomy is the removal of the entire prostate gland. Nerve-sparing surgical removal is important to preserve as much function as possible.
- Transurethral resection of the prostate, or TURP, which also involves removal of part of the prostate gland, is an approach performed through the penis with an endoscope (small, flexible tube with a light and a lens on the end).
- Cryosurgery is a less invasive procedure than surgical removal of the prostate gland. Treatment is administered using probe-like needles that are inserted in the skin between the scrotum and anus. The urologist can also use microwaves.
- Laparoscopic surgery, done manually or by robot, is another method of removal of the prostate gland.
Credit : Hopkins Medicine
TURis Plasma Vaporization
Where and what is the Prostate Gland?
The Prostate gland is at the base of the Bladder and surrounds the urinary passage (urethra). The normal function of the gland is to produce some of the seminal fluid, which is expressed with ejaculation.
How does the gland cause trouble?
With increasing age, the prostate gland enlarges slowly due to the stimulation by the male sex hormone (testosterone). Testosterone is produced by the testicles and therefore the first enlargement of the prostate gland begins at puberty. Slow growth continues in most men as they get older but only causes trouble if it narrows the urinary passage.
What does a prostate operation do?
The latest technique is the removal of the Prostate Gland is with Bi Polar resection and vapourisation in saline. The operation removes the gland and thus allows free passage of urine from the bladder.
The operation is done under anesthesia using a special instrument called a Resectoscope and the Bi Polar button and loop electrode which is passed down the urinary passage. Because there is no cut in the skin, healing after the operation is quicker. It may still be necessary however, to leave a catheter to drain the bladder for 1-2 days. The procedure is done as a Day Case or overnight stay in Hospital unless other concomitant ailments dictate a longer stay.
If the prostate gland is very large, it may be necessary to remove the gland by a cutting operation in the lower abdomen. If this method is preferred, our surgeon will explain the details.
What is TURIS?
The word TURIS emanates from Trans Urethral Resection in Saline. Here the resection of the obstructing part of the prostate gland is removed by Bi-Polar current using cutting and vapourisation in Saline.
What are the advantages of Laser over Standard TURP Operation?
TURIS affords the following advantages:
- Greatly reduced bleeding in most cases resulting in less strain physiologically on your body, reduction in transfusion rate and early discharge from the hospital.
- The irrigation fluid used is Normal Saline and not Glycine which is 10 times more expensive volume for volume.
- This in turn results in diminishing the complication of the TUR Syndrome or Water intoxication and a reduction in cost.
- Post-operative irrigation is not required.
- Retrograde Ejaculation, which is very common after a standard TURP, is almost non-existent in TURIS.
- All the above factors result in cost savings without any compromise whatsoever in the results of surgery!
Further, the cost savings are transmitted to you as we are not charging you more for this procedure. It is estimated that you will on average save Ksh. 40,000 – 60,000.
What are the disadvantages of TURIS?
The disadvantage is that it takes slightly longer to perform the surgery.
After the operation
There is usually some bleeding from the prostate cavity and this causes a red discoloration of the fluid coming from the catheter. This usually stops after a day or two. It helps to drink plenty of fluids after the operation to get a good wash-through of the bladder.
A common fear is that there will be leakage of urine after the operation, but serious leakage is rare. There may be minor leakage for a day or two after the catheter is removed, but this soon stops. There may also be feeling of urgency resulting in the need to pass urine frequently. Both the minor leakage and the urgency occur because there is a raw area inside which has to heal up. If there has been long-standing blockage of the bladder, the bladder itself may be damaged and the need to pass urine frequently may continue for several weeks.
Sometimes blood may appear again in the urine some 10-14 days after the operation. This is caused by the internal healing process and may be aggravated by constipation. This bleeding usually clears up quickly and it helps to drink plenty. In order to minimize this bleeding, we recommend that constipation should be avoided, and it may be necessary to take a mild laxative.
How soon will the urinary stream Improve?
Following the operation there is usually an immediate improvement in the urinary stream and further improvement may continue for up to 6 months. You may find that the frequency of urination does not completely settle down for 2-3 months.
Will the operation affect my sex life?
Sexual intercourse often becomes less frequent with increasing age but there is no reason for the prostate operation to end sex life. Removing the prostate gland does not alter erections of the penis or the sensation of orgasm. Once the operation has healed having sex will not cause damage, but it is best to wait 3-4 weeks.
How long before I can go back to work and become fully active?
This depends on how fit you were before the operation. However most of our patients are advised to go back to work even for half days in a couple of days.
Credit: Laserstone Surgery