Part of the TeachMe Series

Consent: Transurethral Resection of a Bladder Tumour

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Last updated: June 18, 2021
Revisions: 5

Last updated: June 18, 2021
Revisions: 5

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This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

A Transurethral Resection of a Bladder Tumour (TURBT) is a common procedure that is used in both a curative or diagnostic capacity; indeed, it can be used to treat and/or staging newly diagnosed or recurrent bladder tumours. It also has been used for symptom control for treatment of haematuria secondary to bladder neoplasms.

A TURBT is an endourology procedure, whereby following insertion of the cystoscope, the bladder tumours can undergo electrocautery and be removed (at least partially). It is minimally invasive and has the advantage of also being able to deliver targeted therapy to specific site, such as intravesicular chemotherapy agents.

Complications

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Bleeding Damage to the lining of urethra or bladder can cause bleeding Careful and meticulous handling of resectoscope avoiding damage
Damage to surrounding structures Damage can occur to the urethra, bladder, or ureters during the procedure; bladder perforation in severe cases can occur Ensure a good visual field throughout the procedure
Incomplete resection Bulky tumours can make complete resection difficult. Procedure is abandoned for safety and futility reasons
Anaesthetic Risk Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation

 

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain  Dysuria from the instrumentation used and slight urethral dilation from the scope Use of instillagel into the urethra and simple analgesia post-operatively
Infection Infection can be introduced by the instrumentation, however the overall risk is very low Maintain an aseptic technique throughout the procedure
Haematuria Damage to the intraluminal surfaces of the bladder, with inadequate haemostasias can cause post-operative hematuria, including formation of blood clots and resultant clot retention Achieve arterial haemostasis by cautery, if necessary using the rolling-ball electrode; place a triple-lumen Foley’s catheter and set-up ongoing post-op saline irrigation
Urinary retention post-catheter removal Failure to pass urine after the post-operative catheter has been removed, may require a longer period with an indwelling catheter
TURP syndrome Can occur in TURBT if bulky tumour and long intraoperative time. Presents classically with mental confusion, vomiting, hypertension and bradycardia. Occurs with hyponatraemia secondary to absorption of irrigation via the exposed venous channels Reduce operating time to less than an hour and careful use of irrigation solutions rich in glycine
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

 

Late

Complication Description of Complication Potential Ways to Reduce Risk
Stricture Recurrent procedures can lead to the development of urethral strictures
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