Dealing with bladder tumors is like
dealing with weeds in a garden
Bladder tumor removal is a mostly straightforward process
Dr. Chertack has discussed that you have a bladder tumor. This may have been seen with CT imaging or during a clinic procedure called cystoscopy. You may have been having urinary issues, blood in the urine, or no symptoms at all. Dr. Chertack is now recommending a surgery called “transurethral resection of bladder tumor,” or TURBT, to better assess your tumor.
What is a TURBT?
You will be asleep during this surgery. A camera will be inserted into your bladder. Dr. Chertack will then cut out the tumor and any other tissue that does not look normal. He will then stop any bleeding using electric energy to cauterize the tissue. This takes about an hour and you should be able to go home the same day.
Is it cancer?
Unfortunately, it might be bladder cancer, but this is difficult to say at this time. Bladder cancer is the most common cause of bladder tumors, but there are other causes that are not cancer. It can be very difficult to tell based on appearance alone.
When will I find out what my bladder tumor is?
Dr. Chertack will not be able to tell you what type of bladder tumor it is immediately after the surgery. You (and he) will need to wait for the pathologist to examine the tumor under a microscope, this can take 1 or 2 weeks. Dr. Chertack will see you in clinic within 2 weeks to discuss the results and what the next steps will be.
What are the risks of surgery?
It is normal to have some pain and burning with urination for a couple of days.
There is a small risk of bleeding. It is normal to notice a small amount of blood in the urine after surgery, stay hydrated and this should resolve shortly. Some patients notice some scabs or clots in the urine 1-2 weeks after surgery, this is part of the healing process.
There is a small risk of infection, you will get antibiotics in the operating room. If you have an infection before surgery, this will be treated prior to surgery.
Will I need a catheter after surgery?
You may need a catheter temporarily after surgery to drain your urine.
If the tumor is very large, a catheter will be placed after removing the tumor to allow your bladder wall to heal. This catheter will stay in for a couple days, no longer than a week.
Rarely there can be concern for a perforation, or hole, in the bladder wall. To prevent urine from leaking out and to allow the hole to heal, a catheter will be placed and will stay for a couple weeks.
In very rare circumstances the hole can be large and require an incision to repair the hole from the outside of the bladder. Dr. Chertack will be extremely careful and do everything possible to prevent this from occurring.
What do I need to do to prepare for surgery?
Do not eat or drink anything after midnight the night before surgery.
Any other restrictions regarding your medications will be discussed in advance with the anesthesia team.
Dr. Chertack and your other doctors will discuss temporarily stopping any blood thinner medications that you may be taking.
You will be tested for urine infection prior to surgery, if this is present you may need to take antibiotics for a few days before surgery. Please provide a urine sample 2 weeks before surgery to give time to treat any infection.
What restrictions do I have after surgery?
You can eat whatever you want after surgery.
You can do any physical activity you feel comfortable performing after surgery. No driving for 24 hours after surgery. No lifting restrictions.
Having a catheter does not add any restrictions.
What medications will I receive after surgery?
You can take over the counter pain medications (tylenol, ibuprofen) up to 3-4 times daily for pain, usually this is only necessary for a couple days after surgery.
You can take pyridium to treat any pain or burning with urination, take up to three times daily. It will make your urine turn orange.
Senna prevents constipation, take daily until you are having regular bowel movements.
You do not need narcotics after this type of surgery.
What is my follow-up?
You will see Dr. Chertack in 2 weeks to discuss your surgery results. Sometimes he will be able to call you if the results are available sooner. This will determine the next steps for your treatment, if needed. You may need some CT scans, Dr. Chertack will order these if it is necessary.
Like gardens, some bladders require more or less maintenance than others
My results showed cancer! What do I need to know?
The bladder wall has multiple layers. The most important question is whether the cancer has invaded into the muscle layer. If your cancer is not "muscle invasive" then it is considered non-muscle invasive (abbreviated NMIBC).
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I have muscle invasive bladder cancer! What now?
Once your cancer has the ability to invade into the muscle lining, it can also invade into other parts of your body (known as metastasis). You will need more aggressive treatment to prevent the cancer from spreading and eventually leading to death.
The "gold standard" treatment for muscle invasive bladder cancer is chemotherapy followed by a surgery to remove your bladder (and prostate). Since your kidneys will continue to make urine, your surgeon will create a "urinary diversion," which uses a piece of intestine to allow the urine to drain out of your body.
Dr. Chertack will discuss your diagnosis with you. He will discuss the need for further imaging and will refer you to an oncology doctor to discuss chemotherapy options and one of his colleagues to discuss surgical options.
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What if I do not have muscle invasive cancer?
If you have non-muscle invasive bladder cancer, you will be put in a risk category (low, intermediate, or high).
Your cancer will be managed with a combination of cystoscopy (to catch any new tumors) and "intravesical chemotherapy." This is a treatment put into your bladder to kill small collections of cancer cells and decrease the chances of recurrence.
Low risk patients only need cystoscopy appointments to watch for recurrence.
Intermediate risk patients receive cycles of chemotherapy, usually gemcitabine or mitomycin, combined with regular cystoscopy visits.
High risk patients usually receive BCG into the bladder - this is the tuberculosis vaccine, which was found to decrease bladder cancer risk! You will also need regular cystoscopy visits.
Dr. Chertack will help monitor for cancer recurrence. Every patient follows a different treatment path, he will help guide you along the best path for you.
