TURBT: removing a bladder tumour through the urine tubeTURBT: peshab ki nali ke raaste bladder ki gilti nikalna

Yeh kya hai aur kyun kiya jata hai

Gilti (tumour) aksar pehle bladder ke camera test (dekhein flexible cystoscopy ki guide) ya scan par nazar aati hai, aam tor par peshab mein khoon aane ke baad (dekhein peshab mein khoon ki guide). TURBT us ke baad ka qadam hai. Aik patli doorbeen jise resectoscope kehte hain, urethra se guzar kar bladder mein jati hai, aur us ki nok par bijli wala taar ka halqa gilti ko tukdon mein kaat kar nikalta hai.

TURBT ke do kaam hain. Yeh nazar aane wali gilti ko nikalta hai, aur laboratory ko woh tissue deta hai jis se pata chalta hai ke yeh cancer hai ya nahi, kis qisam ka hai aur bladder ki deewar mein kitna gehra hai. Isi maloomat se tay hota hai ke aage kaunsa ilaaj chahiye (dekhein bladder cancer ki guide).

Procedure se pehle

• Pehle peshab ka test hota hai. Peshab ke infection ka operation se pehle ilaaj hota hai (dekhein peshab ke tests ki guide).
• Scan: shayad pehle CT scan ya ultrasound ho chuka ho. Apne nateeje saath layein (dekhein CT scan ki guide).
• Khoon patla karne wali dawayein aur kisi bhi allergy ke baare mein team ko batayein. Apne taur par koi dawa band na karein. In dawaon ko operation ke aas paas ehtiyaat se tay karna padta hai.
• Bay-hoshi: TURBT aam tor par poori bay-hoshi mein hota hai, ya kabhi spinal anaesthetic mein (kamar mein injection jo jism ka neeche ka hissa sunn kar deta hai). Khaane peene ke baare mein jo hidayaat milein un par amal karein.
• Aap se razamandi (consent) maangi jayegi. Poochhein ke agar gilti cancer nikli to kya hoga, aur nateeja kab milega.
• Qeemat, operation kahan hoga aur aap usi din ghar jayenge ya raat rukna hoga, yeh bhi poochh lein.

Procedure ke dauran

Anaesthetic ke asar ke baad resectoscope urethra se guzar kar bladder mein jati hai. Surgeon poore bladder ko dekhta hai, phir taar ke halqe se gilti ko tukdon mein kaat kar nikalta hai aur khoon behne ki jagahon ko seal karta hai. Surgeon gilti ki jad se bhi kuch tissue leta hai taake laboratory bata sake ke woh kitni gehri hai.

Tukdon ko dho kar laboratory bheja jata hai. Kabhi kabhi operation ke foran baad bladder mein chemotherapy dawa ki aik khuraak rakhi jati hai taake gilti ke dobara ugne ka imkaan kam ho. Aakhir mein aam tor par urethra ke raaste bladder mein catheter (patli nali) rakhi jati hai. Yeh aksar aik din ke andar, aur kabhi usi din, nikal di jati hai.

Procedure ke baad aur recovery

Hospital mein

• Peshab shuru mein gulabi ya surkh hota hai aur aam tor par aik do din mein saaf ho jata hai. Agar catheter lagi ho to woh peshab kaafi saaf hone tak rehti hai.
• Bladder ke spasm (aithan aur peshab ki hajat ka ehsaas) aam hain. Nurses ko batayein, woh madad kar sakti hain.
• Bohat se log usi din ya agle din ghar chale jate hain. Jane se pehle team dekhti hai ke aap peshab kar sakte hain.

Ghar par

• Bohat paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho. Is se peshab saaf rehta hai.
• Peshab mein jalan, zyada baar peshab aana aur achanak hajat aik do haftay aam hai, aur peshab mein kabhi kabhi khoon aata jata rehta hai.
• Khurand (scabs) aik se teen haftay baad alag ho kar naya khoon la sakte hain. Aaram karein aur paani peeyein. Agar khoon zyada ho ya peshab na aaye to fauran madad ka dabba dekhein.
• Qabz aur zor lagane se bachein. Rayedar ghiza khayein aur zaroorat ho to qabz ki halki dawa ke baare mein poochhein.
• Sargarmi: roz chalein, lekin do haftay tak bhaari wazan uthane aur zor wali kasrat se parhez karein, jaisa mashwara ho. Gaari aur kaam ke baare mein team se poochh lein.

Mumkina khatrat

• Aam: peshab mein khoon, aik do haftay jalan aur zyada baar peshab aana, aur bladder ke spasm.
• Kam aam: peshab ka infection, khoon jis ke liye catheter zyada der rakhni ya dobara dhulaayi karni pare, aur khoon ka lothra jo catheter band kar de.
• Ghair aam: gilti ka poori tarah na nikalna jis ki wajah se doosra muaina operation karna pare, aur baad mein peshab ki nali ka tang ho jana (dekhein peshab ki nali ki tangi ki guide).
• Bohat kam: bladder ki deewar mein suraakh, jis ke liye catheter zyada der rakhni padti hai aur bohat kam us ki marammat ka operation, taang ya phephre mein khoon ka lothra, ya anaesthetic ke khatrat.

Nateeje aur follow-up

• Tissue ka nateeja aam tor par aik do haftay mein aata hai. Is se pata chalta hai ke gilti cancer hai ya nahi, kis qisam ki hai aur kitni gehri hai. Poochh lein ke nateeja kab aur kaise bataya jayega, aur yaqeeni banayein ke aap ko mile.
• Nateeja agla qadam tay karta hai. Kuch logon ko sirf baqaida camera check chahiye hote hain. Doosron ko muaina operation, bladder mein rakhi jane wali dawa, ya doosra ilaaj chahiye hota hai. Aap ki team batayegi ke aap ke liye kya hai (dekhein bladder cancer ki guide).
• Baqaida check cystoscopy aksar kayi saal chahiye hoti hain kyunke gilti dobara ug sakti hai (dekhein flexible cystoscopy ki guide).
• Agar peshab mein dobara khoon nazar aaye to agle check ka intezar kiye baghair apne urologist ko batayein.

Aam sawalaat

What it is and why it is done

A growth (tumour) is often first seen on a camera test of the bladder (see the flexible cystoscopy guide) or on a scan, usually after blood in the urine (see the blood in urine guide). TURBT is the next step. A thin telescope called a resectoscope is passed along the urethra into the bladder, and a wire loop at its tip, carrying an electric current, cuts away the growth in pieces.

TURBT has two jobs. It removes the visible growth, and it gives the laboratory the tissue needed to say whether it is cancer, what type it is and how deeply it goes into the bladder wall. That information decides what treatment is needed next (see the bladder cancer guide).

Before the procedure

• A urine test is done first. A urine infection is treated before the operation (see the urine tests guide).
• Scans: you may have had a CT scan or ultrasound first. Bring your results (see the CT scans guide).
• Tell the team about blood thinners and any allergies. Please do not stop any medicine on your own. These medicines usually need careful planning around the operation.
• Anaesthetic: TURBT is usually done under a general anaesthetic, or sometimes a spinal anaesthetic (an injection in the back that numbs the lower body). Follow the instructions about eating and drinking.
• You will be asked for consent. Please ask what will happen if the tumour turns out to be cancer, and when you will get the result.
• Ask about the cost, where it will be done and whether you will go home the same day or stay overnight.

During the procedure

With the anaesthetic working, the resectoscope is passed along the urethra into the bladder. The surgeon looks all around the bladder, then cuts away the growth in pieces with the wire loop and seals the bleeding points. The surgeon also takes some tissue from the base of the growth, so the laboratory can tell how deep it goes.

The pieces are washed out and sent to the laboratory. Sometimes a single dose of a chemotherapy medicine is placed in the bladder shortly afterwards, to lower the chance of the growth coming back. At the end, a catheter (a thin tube) is usually placed in the bladder through the urethra. It is often removed within a day, and sometimes the same day.

After the procedure and recovery

In hospital

• The urine is pink or red at first, and usually clears over a day or two. If you have a catheter, it stays in until the urine is clear enough.
• Bladder spasms (cramping and a feeling of needing to pass urine) are common. Tell the nurses, as they can help.
• Many people go home the same day or the next day. The team will check that you can pass urine before you leave.

At home

• Drink plenty of water unless told otherwise. This keeps the urine clear.
• Burning, passing urine more often and urgency are common for a week or two, and some blood in the urine may come and go for a couple of weeks.
• Scabs can come away about one to three weeks later and cause some new bleeding. Rest and drink water. See the urgent help box if the bleeding is heavy or you cannot pass urine.
• Avoid constipation and straining. Eat fibre and ask about gentle stool softeners if needed.
• Activity: walk daily, but avoid heavy lifting and strenuous exercise for a couple of weeks, as advised. Ask the team about driving and work.

Possible risks

• Common: blood in the urine, burning and passing urine more often for a week or two, and bladder spasms.
• Less common: a urine infection, bleeding that needs a longer catheter stay or a washout, and a blood clot blocking the catheter.
• Uncommon: the growth not being completely removed, so that a second look operation is needed, and a narrowing (stricture) of the urethra later on (see the urethral stricture guide).
• Rare: a hole through the bladder wall, which may need a catheter for longer or, rarely, an operation to repair it. Other rare risks are a blood clot in the leg or lung and the risks of the anaesthetic.

Results and follow-up

• The tissue result usually takes one to two weeks. It tells you whether the growth is cancer, what type it is, and how deeply it goes. Ask how and when you will be told, and make sure you receive the result.
• The result decides the next step. Some people need nothing more than regular camera checks. Others need a second look operation, medicine placed in the bladder, or other treatment. Your team will explain which applies to you (see the bladder cancer guide).
• Regular check cystoscopies are often needed for some years, because growths can come back (see the flexible cystoscopy guide).
• If you see blood in your urine again, tell your urologist rather than waiting for the next check.

Common questions