Transurethral resection of bladder tumors is an important method for the treatment of superficial bladder tumors. The following information is based on my experience, and I hope it will be beneficial to patients.
Transurethral bladder tumor electrosurgery (TUR-Bt) is indicated for superficial bladder metastatic cell carcinoma that has not invaded the muscular layer.
Preoperative preparation
①No smoking one week before surgery.
② Antibiotic skin test one day before surgery.
③Take laxatives to empty the gastrointestinal tract the evening before surgery.
④Eat a normal diet at noon one day before surgery.
⑤Eat a light and easily digestible diet in the evening.
⑥Fast after 8:00 p.m. the night before surgery.
⑦No drinking after 12:00 p.m. the night before surgery.
On the day of surgery (before entering the operating room)
①Laxative enema in the morning of surgery.
② Receive the first surgical patient between 7:30-8:30 am on the morning of surgery.
③The following items need to be brought to the operating room at the same time.
Relevant imaging data (CT, X-ray film, imaging, etc.).
Sterilized water for injection 500m×20 bottles.
Pyridoxine for injection 10mg×3pcs.
On the day of surgery (during surgery)
①Anesthesia is usually general anesthesia with tracheal intubation.
②It takes 30 min to complete induction of anesthesia and tracheal intubation.
③It takes about 10-30min from the start of surgery to the end of surgery.
④Immediate postoperative bladder instillation chemotherapy (birubicin 30mg for 30min).
⑤ Recovery from anesthesia after the completion of surgery takes about 1-2 hours (the exact time is determined by the depth of anesthesia and the patient’s metabolic rate).
⑥A postoperative urinary catheter is left in place with continuous bladder irrigation.
On the day of surgery (return to the ward after surgery)
①Continuous oxygen inhalation.
②Strictly abstain from diet (patients often appear thirsty and can moisten their lips and mouth with water on cotton swabs, but no drinking).
③Continue bladder flushing after surgery, pay attention to the color of the flushing fluid, and notify the responsible nurse and the physician in charge in time if there is fresh bleeding (contact the nurse on duty during off hours).
④ Encourage patients to breathe deeply and move their limbs in bed.
⑤ May lie on his or her side.
⑥Return to the ward for 4-6 hours to rest on pillows.
⑦Family members assist the patient to move the lower limbs once an hour (to avoid venous thrombosis of the lower limbs).
The first day after surgery
Normal diet (bladder tumor electrosurgery anesthesia is short and has little effect on the gastrointestinal tract, but pay attention to eating less and more meals).
Bladder irrigation can usually be discontinued.
It is necessary to get out of bed (the sooner you get out of bed, the faster you will recover after surgery).
Postoperative days 2-5
Diet and water intake are the same as before.
The duration of urinary catheter retention is determined by the depth of surgical resection. If it is more superficial, the urinary catheter can be removed 2-5 days after surgery; if the electrodes are deeper, it is recommended to remove it after bladder irrigation and chemotherapy again 7 days after surgery (as decided by the doctor in charge).
The longer the retention time of urinary catheter, the more common the occurrence of urethral infection and urethral stricture, and the less frequent, urgent and hematuric urination after removal of the catheter (personal opinion).
The shorter the duration of indwelling urinary catheter, the less common the occurrence of urethral infection and urethral stricture, and the more common the urinary frequency, urgency and hematuria after extubation (personal opinion).
Precautions after discharge
①No smoking (the occurrence of bladder tumors is closely related to smoking).
②Regular bladder perfusion (see later for specific protocol and precautions).
③Regular review (cystoscopy).
④Bladder tumors are prone to recurrence, and promptly seek medical attention if there is hematuria.
Routine protocol of postoperative bladder perfusion chemotherapy (specific protocol to be decided by competent physician according to postoperative pathological results)
Immediate bladder perfusion: perfusion is completed within 6h after surgery (if there is no obvious bleeding perfusion is usually completed in the operating room).
Early bladder perfusion: postoperative bladder perfusion once a week for 6-8 weeks.
Maintenance bladder perfusion: postoperative bladder perfusion once a month for 8-12 months.
Drug of choice.
Pyrrolizidine 30mg dissolved in 40m 5% dextrose.
Bladder perfusion precautions.
No drinking 2h before and 30min after perfusion (to avoid producing urine to dilute the drug).
Keep 30min after instillation, during which the position can be changed to make full contact between the drug and the walls of the bladder, and then excreted by itself.