What is a bladder lesion?
Bladder lesions are abnormal growths or tumours on the bladder lining. They are removed by having an operation called a transurethral resection of bladder tumour (TURBT).
TURBT is usually done under general anaesthesia. This means you will be asleep during the operation and will feel no pain. You may need to stay a night or two in hospital depending on the extent of your surgery.
Your surgeon will explain the potential benefits of having bladder lesions removed and discuss the associated risks and alternatives to the treatment.
If you have had surgery to remove a bladder lesion, a course of mitomycin or BCG is often given directly afterwards to help ensure all the abnormal cells are killed off, and to lower the chance of new lesions forming. This is called adjuvant treatment because it is in addition to the surgery. Mitomycin is an anti-cancer (chemotherapy) drug that attacks and destroys cancerous cells. BCG is a type of immunotherapy because it works by encouraging your body’s own immune system to attack cancerous cells. BCG is a weakened form of a germ called Mycobacterium bovis, which is also used to vaccinate against tuberculosis.
If the bladder lesion is found to be cancerous, you may also continue have the mitomycin or BCG treatment once a week for six weeks in the out-patient department.
About the operation
A thin rod-like instrument with a tiny light and lens on the tip, called a cystoscope, will be carefully inserted into the urethra (the tube that carries urine out of the body). Saline solution (salt water) will be passed through the cystoscope to fill the bladder up and to make the whole of the lining visible.
Your surgeon will find the lesion and insert a special wire loop through the cystoscope. An electric current is passed down the wire loop and used to cut or burn off the lesion. This also seals the wound to stop any bleeding. Some healthy tissue around the lesion may also be removed.
At the end of the procedure, the cystoscope is taken out and a catheter (a thin flexible tube) is passed in to the urethra and left in place for about 24 hours. The catheter will drain urine from your bladder into a bag. The catheter may also be connected to a system which washes any blood and blood clots out of your bladder. This is called bladder irrigation.
The removed lesions are sent to a laboratory for examination. If the bladder lesion is cancerous, the tests will show how far the cancer has spread and if further treatment is required. In some cases, removing the lesion is all that is needed. The procedure usually lasts 30 minutes (slightly longer if more than one lesion is present).
If you are given Mitomycin or BCG, it will be mixed with saline (salt water) to make about 50ml of solution. A syringe will be connected to your catheter to get the medicine into your bladder. Giving drugs directly into the bladder means very little is absorbed into the rest of the body and so there are fewer side-effects. The medicine is left in the bladder for about two hours, then drained out again.
After a catheter is removed you may feel some discomfort especially when passing urine. This should settle after about 48 hours. There may also be some blood in the urine. Depending on the extent of the surgery, this may last for 10 to 14 days.
Surgery to remove bladder lesions is commonly performed and generally safe. For most people, the benefits are greater than any disadvantages. However, all surgery carries an element of risk.
The main complications specific to TURBT are listed here.
- Possible difficulty in passing urine (urinary retention) soon after the operation. This may require temporary insertion (or re-insertion) of a catheter.
- Urinary tract infection. The risk of infection remains higher for a few weeks after the operation. You may need antibiotics to treat infection.
- Very rarely the urethra or bladder may be damaged or perforated. This can create scar tissue. Further cystoscopy may be required to remove the scar tissue or repair any damage.
- There is a chance that the lesion or tumour will re-occur or not be completely removed. If this happens further surgery may be needed.
Having bladder treatment with mitomycin or BCG is also generally safe. On rare occasions, the weakened bacteria in the BCG treatment can cause an infection, causing a high temperature or fever and make you feel unwell. This usually passes within 48 hours. However, a severe infection would need treatment with anti-tuberculosis drugs.
Also rarely, mitomycin can affect the bone marrow, which is responsible for making new red and white blood cells. This can result in anaemia and make you more vulnerable to infection. Mitomycin can also irritate the skin, so you may develop a skin rash. If these complications occur, your treatment may be stopped.
The chance of complications depends on the exact type of treatment you are having and other factors such as your general health. You should ask your surgeon to explain how any risks apply to you.
To make an appointment or to ask for a guide price, please call our enquiry team on 0800 434 6600.
Please refer to our website notices and disclaimer page when reading any treatment summary.
