Transurethral resection of the bladder: postoperative period and recovery

The procedure for assessing the conditions of the tissues of the bladder or their fence for a biopsy is a transurethral resection. Consider its features and indications for the conduct.

The bladder is a hollow muscular organ located in a small pelvis. It is a reservoir for urine, which is excreted by the kidneys. In some cases, tumor organisms appear on the mucous organ, requiring diagnosis and surgical treatment.

TUR of the bladder is a high-tech endovideososcopic operation. This type of surgery significantly differs from the open surgery, as it does not require cuts from the outside and is performed with an endoscope.

The main advantages of TUR before open resection:

• Minimal tissue trauma.
• Minimal blood loss during surgery.
• Minimal risk of infectious complications.
• An easy and fast recovery period with a low probability of postoperative complications.
• There is no possibility of opening the seam.

By its effectiveness, transurethral resection is not inferior to open surgery. Most often it is carried out with various neoplasms on the bladder mucosa. During the procedure, the surgeon inserts his instruments - a cystoscope (a thin tube with lenses and a light source) into the urethra. TUR is considered the only method that can remove superficial cancer.

Indications for the procedure

The main advantage of TUR before other methods of surgical treatment is the absence of the need to disrupt the integrity of the skin and soft tissues. The entire procedure is performed with the help of fine instruments inserted into the urethra. Let's consider the basic indications for conducting a transurethral resection of the bladder:

• Diagnosis and treatment of tumors.
• Biopsy of organ tissues.
• Intensive manifestation of prostatic adenoma.
• Benign prostatic hyperplasia.
• Difficulties with the withdrawal of urine from the body.
• Frequent nighttime urination.
• Bacterial or viral infections of the genitourinary system in men.
• Sensation of a small amount of fluid in the bladder.
• Complications after incomplete or improperly formulated early treatment.
• Damage to the kidneys (mechanical, biological) and violation of their functions.
• Uncontrolled urinary process caused by damage to the bladder.
• Bleeding from the urinary canal.
• Concrements in the urinary system.

In addition to indications, surgical intervention has a number of contraindications. TUR is not performed with exacerbation of chronic diseases of the cardiovascular and excretory system, diabetes, as well as in pelvic joint pathologies, which limit the operating field.

TUR with a tumor of the bladder

Surgical endoscopic procedure aimed at diagnosis and treatment of tumors is TUR. With a tumor of the bladder, transurethral resection is necessary for:

• Establishment of a histological diagnosis (determination of the degree of malignancy).
• Determination of the stage of the tumor process (the penetration of cancer cells into the muscle layer).
• Detection of tumor prognostic factors: localization, stage, size, quantity.
• Effective removal of neoplasm.

To date, TUR with a bladder tumor is the best method for treating early stages of malignant processes. Resection is especially effective in exophytic tumors that grow in the lumen of the organ.

[1], [2], [3], [4], [5]

TUR in bladder cancer

To confirm such a diagnosis as a bladder cancer, many diagnostic methods are used. Most often the patient undergoes biopsy, cystoscopy, cytology and urine culture, intravenous and retrograde pyelography.

A tour of bladder cancer is conducted under the following conditions:

• Early stages of malignant process. Cancer has affected only the mucous membrane, the muscles are not affected.
• The dimensions of the lesion do not exceed 5 cm.
• Lymph nodes are not affected by metastases.
• The urethra and the area of the sphincter of the ureter are not damaged by the disease.

Transurethral resection has specific goals:

• Removal of the tumor.
• Study of the neoplasm.
• Study of the inner membrane of the bladder and the identification of concomitant pathologies.
• Tissue collection for biopsy.

As a rule, the cancer begins as a superficial tumor. The first sign of pathology is the blood in the urine. Malignant neoplasms have a certain classification from 0 to IV stage. The lower the stage, the less the spread of cancer. High stages indicate a greater severity of the disease.

Very often, bladder tumors are accompanied by additional pathologies from the urinary system. TUR allows to take a part of tissues on a biopsy from several parts of the organ and to reveal pathological processes. The advantage of this diagnostic and therapeutic method is that it does not cause such traumatization of tissues as open methods. After the procedure, there is a small wound that heals within 4-6 weeks. The recovery period is fast and almost painless.

TUR with leukoplakia of the bladder

An extremely rare disease that develops against a background of chronic infection and most often in women is leukoplakia. TUR with leukoplakia of the bladder is used for both diagnostic and therapeutic purposes. The pathological condition is characterized by changes in the mucous membrane of the organ, in which the transitional epithelium is replaced by a multilayered epithelium. Over time, this leads to keratinization of the newly formed layer. The coarsened tissues disrupt the normal functioning of the organ. The disorder is considered a precancerous condition, since there is a risk of oncogenic plaque type.

The main cause of the disease is chronic infections of the genitourinary system. Most often, leukoplakia occurs due to trichomonads, gonococcus, ureplasmosis, chlamydia and other pathogens.

There are three types of leukoplakia of the bladder:

• Flat - on healthy tissues a deposit of gray or white with clear contours is formed.
• Verruccular - repeats the flat form, but changes include knots that approach each other.
• Erosive - small ulcerous lesions are added to the symptoms of the two above-mentioned forms.

The most dangerous are erosive and verruzed forms, as they lead to the development of malignant cells. Symptoms of leukoplakia occur as an inflammatory process and affect the process of urination:

• Frequent urge to urinate, which worsen at night.
• Aching and pulling pains in the lower abdomen with a full bladder.
• Violation of urination: incomplete emptying, burning, interruption of the jet.
• Fast fatiguability.
• General weakness.

Symptoms of the disease are often confused with cystitis. For diagnostics use various methods, most often: laboratory studies, cystoscopy, ultrasound of the pelvic organs, biopsy of the walls of the bladder. A comprehensive diagnostic approach allows you to correctly diagnose and determine the area of the lesion.

Treatment is carried out by both medicamental and surgical methods. Conservative therapy is carried out with the help of installations with a solution of sodium chloride, heparin, lidocaine. The operation is performed with a large area of tissue damage and with a suspicion of malignancy of the process.

Transurethral resection with leukoplakia is the removal of pathological mucosa by means of a special loop. Access to the lesion is via the urethra with the help of a cystoscope. After such a procedure, the integrity of the walls of the bladder is preserved. Another option for treating the disease is laser coagulation of the mucosa and laser ablation. The recovery period after TUR is rapid, the risk of complications or recurrences of the disorder is minimal.

Preparation

Transurethral resection of the bladder is a surgical procedure, before which the patient is given special preparation.

• 3-10 days before endovideoscopy it is necessary to hand over the whole complex of laboratory (blood, urine) and instrumental examinations. An electrocardiogram and chest X-ray are mandatory.
• Before the TUR the patient is consulted by the therapist and anesthesiologist. The general condition, presence of chronic diseases and possible risks of the operation are assessed. The type of anesthesia is chosen.
• In the evening before resection, a cleansing enema is placed and the operating field is cleared. During this period you can not eat.
• In the morning before TUR, the patient is given antibiotics to prevent infection and is sent for surgery.

If there are contraindications or significant health risks, the TUR is postponed until the patient's condition is normalized.

[6], [7], [8], [9], [10]

Technique of the tOUR of the bladder

TUR is a minimally invasive surgical procedure that is less aggressive in nature, unlike open adenomectomy. The technique of transurethral resection of the bladder consists of:

• After preparation for the procedure, the patient is laid on his back on the operating table. In this case, the legs should be bent and bent at the knees.
• Through the urethra, a cystoreceptoscope is inserted into the bladder. The organ is filled with a sterile solution. All surgical procedures are controlled by a doctor, and the image is displayed on the monitor.
• After examining the organ, tissue is taken to a biopsy or tumor tumor is removed with a cystorezectoscope. The bed of the removed tissues to prevent bleeding is coagulated.
• The resulting tissue or tumor fragment is sent for histology to determine the type of neoplasm and its nature.
• After this, a temporary catheter is inserted into the bladder through the urethra. This is necessary for irrigation of the organ with chemotherapy to prevent relapse of the disease.

Transurethral resection can be performed under general or under spinal anesthesia. If the first variant of anesthesia is chosen, then the entire period of the operation the patient is unconscious. With spinal anesthesia, the lower half of the body is anesthetized and the patient is conscious. The choice of anesthesia depends on many factors, in particular on the condition of the patient's body, the planned amount of intervention and indications for its conduct.

Tendency of the neck of the bladder

A fairly common disease from the urogenital system in men is sclerosis of the neck of the bladder. Because of the inflammatory process, scar tissue is formed, which gradually grows and narrows the lumen of the neck. Narrowing of the urethra and bladder provokes urination disorders and leads to stagnation of residual urine in the organ.

The disease most often develops against a background of chronic inflammation of the prostate or as a complication after surgical manipulations on the prostate. For diagnosis, ultrasound of the genitourinary system, urethrography, urethroscopy, uroflowmetry and a number of other examinations are carried out.

TUR of the neck of the bladder is a surgical method of treating the disease. The operation is carried out without disrupting the integrity of the tissues. The main purpose of the procedure is resection of scars on the cervix, narrowing the lumen. After transurethral treatment, the patient is prescribed a course of antibiotics. In some cases, after the TUR, the disease recurs, which is a direct indication for another operation.

Contraindications to the procedure

Transurethral resection of the bladder, like any other operation, has certain contraindications to the conduct. Consider these:

• Serious pathology from the cardiovascular system.
• Renal or hepatic insufficiency.
• Violation of blood clotting.
• Infectious diseases.
• Cold, SARS.
• Infectious lesions of the urinary system.

Before planning the procedure, it is necessary to take into account that because of the peculiarities of the physiological structure of the urethra, men tolerate TUR much more complicated than women.

[11], [12], [13],

Consequences after the procedure

Some patients face certain consequences after the procedure of transurethral resection. The first days after the operation, there are marked painful sensations in the bladder and urethra. Such an early postoperative period may be accompanied by impurities of blood to the urine. Such symptoms are temporary and do not threaten the patient's life.

But if the painful condition persists for more than 3-5 days and is supplemented by such symptoms as: a rise in body temperature above 37 ° C, a dark urine with an unpleasant odor, blood clots in the urine, you should consult your doctor.

One of the most common negative consequences of TUR is bleeding, the formation of blood clots in the veins and the body's reaction to anesthesia. Very rarely, after surgery, there are infectious diseases of the urinary system, abrasions and wounds on the tissues of the organ walls, difficulty urinating due to obstruction of the urethra. Such consequences require careful diagnosis and treatment.

[14], [15], [16]

Complications after the procedure

According to medical statistics, complications after the TUR procedure of the bladder develop in every 3-5 patients. Most often, patients face such problems:

• Bleeding from the wound surface.
• Perforation of the bladder.
• Infectious complications.
• Acute fluid retention.
• Acute pyelonephritis.
• Bacteriemic shock.
• Urosepsis.

In addition to the above, a fairly frequent complication is cystitis. This is due to a violation of the contractile function of the bladder. Cystitis is characterized by pain during urination, and in some cases, problems with its implementation. To resolve this, seek medical attention.

[17], [18], [19], [20]

Blood in the urine after a bladder tour

Such a symptom, as the blood in the urine after the TUR of the bladder, occurs in many patients. As a rule, the hematuria is a temporary consequence of the operation. Surgical intervention leads to the fact that the urine acquires a pinkish or orange-red hue. Blood clots are also possible. This disorder passes independently 2-4 days after the procedure.

If the blood in the urine persists for a long period after TUR, this indicates the development of serious complications. Hematuria can be a sign of serious trauma to the mucosa of the bladder, signaling a chronic form of cystitis or inflammation of the walls of the urethra, that is, urethritis. To diagnose and treat a painful condition, you should consult your doctor.

[21], [22]

Pain after bladder tour

Many patients face such a problem as pain after TUR of the bladder. First of all, the discomfort is due to a recent surgical intervention, during which there was a selection of tissues for a biopsy or removal of the detected lesions.

Pain is temporary. If the pain is rather acute and intense, then anesthetic drugs are prescribed, which make the recovery period more comfortable. Caution should be the symptoms, in which pain is accompanied by problems with urination, blood clots in the urine and other pathological signs. In this case, seek medical help immediately.

Bleeding after a bladder tour

The most common complication is bleeding after a TUR of the bladder. As a rule, this symptom is temporary and passes independently for several days after the operation. If the bleeding is intense, it may be necessary to wash the bladder, after which the patient is shown bed rest.

Bleeding after transurethral resection may be associated with bladder perforation. This complication is the second after bleeding in the frequency of occurrence after TUR. To eliminate it, additional surgical intervention is required.

[23], [24], [25]

Cystitis after bladder tour

Often after an operation on the organs of the genitourinary system, cystitis develops. After TUR of the bladder, this complication occurs frequently. Inflammation of the mucous membranes of the body indicates an infectious infection. It can be streptococcus, Staphylococcus aureus, Proteus, Escherichia coli and other pathogens.

Cystitis can be associated with local circulatory disorders and stagnation of urine in the bladder. The disease is characterized by painful sensations in the lower abdomen and cuts during urination. In urine there may be impurities of blood. To eliminate postoperative cystitis, drug therapy is indicated.

[26], [27], [28]

Pseudomonas after bladder

A special place among pathogens of urinary tract infection is the Pseudomonas aeruginosa. After TOUR of the bladder, it is extremely rare and indicates postoperative problems. This malignant microorganism is characterized by increased resistance to most antimicrobial agents and can cause serious infectious complications from the urogenital system.

• Pseudomonas aeruginosa is able to synthesize a water-soluble phenazine pigment - piocyanin. It stains the nutrient medium in a blue-green color. This greatly simplifies the identification of gram-negative bacteria.
• The source of infection may be poorly disinfected instruments and apparatus, solutions or medicines, which contain an inadequate bacteriostatic agent.
• Infection is possible with congenital malformations of the genitals, often recurring catheterization, prostatectomy.

Pseudomonas aeruginosa after a bladder tour is dangerous in that it can take months, and sometimes even years, causing a disturbance in kidney function. The asymptomatic course of the urogenital infection passes into a generalized form, which is characterized by the phenomena of sepsis, from transient episodes of fever to septic shock.

To diagnose the infection, laboratory bacterioscopy and various serological tests are performed. For treatment, peptide antibiotics (polymyxins), broad-spectrum penicillins, aminoglycosides are used. Immunoprophylaxis of Pseudomonas aeruginosa is also shown.

Care after the procedure

Transurethral resection of the bladder, like any surgical intervention, needs a recovery period. Care after the procedure is divided into procedures conducted in the hospital and at home.

In the hospital:

• In the urinary bladder, a catheter is placed to drain the urine, which is left overnight. To wash the body of blood clots, it can be injected with water.
• The urine collection container should be below the level of the bladder.
• Immediately after the operation and until the next morning, bed rest is shown.
• During the first days after the procedure, it is necessary to perform the exercises prescribed by the doctor.

At home:

• It is necessary to regularly clean the area of the catheter insertion. Soap and water can be used for this.
• To clean the bladder, drink as much liquid as possible.
• For 1-1,5 months after the operation, heavy or strenuous work is contra-indicated.
• For 1-2 months after TUR, sexual activity is prohibited.
• You should give up alcohol, spicy food and caffeine.

With proper care after the procedure, the recovery takes about three weeks. During 3-5 days, painful sensations and frequent urination remain, which gradually come to naught.

[29], [30], [31], [32],

How to behave after a bladder tour?

Many patients who have experienced an operation on the organs of the genitourinary system do not know how to behave after. TOUR of the bladder needs a rehabilitation period. Immediately after the procedure, the patient is prescribed antibacterial therapy, which lasts 5-7 days.

1-2 days after TUR, the doctor removes the urinary catheter. After its removal, there may be sharp pains and burning in the urethra, clean urination to the toilet, urination with a small volume, the presence of impurities or blood clots in urine. Similar phenomena occur after 7-14 days.

Immediately after transurethral resection, the patient is shown a bed rest and a dynamic observation in the urologist. After discharge from the hospital, the patient receives nutritional recommendations and a course of physiotherapy procedures that speed up the recovery process.

Postoperative period after bladder tour

Time after any surgery is very responsible. The postoperative period after TUR of the bladder largely depends on the indications for surgical intervention. The patient is shown drug therapy, a special diet and a course of physiotherapy.

During rehabilitation, it is contraindicated to eat spicy or acidic foods, alcohol and drinks with caffeine. If these recommendations are not observed, it is possible to change the composition of urine and its irritating effect on a fresh wound. First time after endovideoscopy should drink a lot of fluids. This is necessary for effective washing of the bladder, preventing infectious infections and constipation.

Physical stress should be limited within 2-3 weeks. Sexual activity is also prohibited until the doctor gives permission. During defecation should not strain and, if necessary, should take laxatives. If the above contraindications are violated, there is a risk of bleeding and a number of other dangerous complications.

Chemotherapy after a bladder tour

If transurethral resection is prescribed for malignant neoplasms, the patient is shown chemotherapy. After TUR of the bladder, it is necessary to prevent recurrence of the disease or the destruction of metastases in other organs and tissues. Immediately after the operation, the chemotherapy is administered to the affected organ and an irrigation system is installed to control the discharge from the urea.

• If malignant disease occurs in the early stages, then intravesical chemotherapy is used. This method is performed after TUR of tumors that have a relapse rate of 60-70%. The drug is injected into the organ and left there for several hours. The medicine is removed during urination. Therapy is carried out once a week for several months.

• With recurrent tumors that penetrate into neighboring organs, tissues and regional lymph nodes, systemic chemotherapy is used. The main goal of such treatment is to destroy the remaining cancer cells.

Chemotherapy is carried out both before and after TUR. Chemotherapy drugs can be administered in cycles. Most often, patients are prescribed a combination of: Methotrexate, Vinblastine, Doxorubicin and Cisplatinum. Medications are administered intravesically, that is, through a catheter, intra-arterially or endolymphatically.

[33], [34], [35],

Recovery after a bladder tour

After a surgical endoscopic procedure, the patient is waiting for a course of rehabilitation aimed at normalizing the work of the body. Recovery after TUR of the bladder takes about 1-2 months. The rate of recovery depends on the reason for the operation and the individual characteristics of the patient's body.

The patient spends the first days after the procedure in a hospital. With the help of an established catheter, the bladder is continuously washed from the blood or medication is administered. The patient is prescribed a course of antibiotics. Also shown is a gentle diet and bed rest. After 2-3 days the patient is discharged home, and a course of physiotherapy is prescribed to speed recovery after surgery.

If TUR was carried out because of malignant neoplasms in the bladder, then after the procedure, systematic cystoscopy is necessary. Diagnosis is associated with a high risk of recurrence of the disease. The first three years after TUR, cystoscopy is performed every 3-6 months, and then once a year. If during the examination signs of recurrence are revealed, then a repeated transurethral resection with subsequent chemotherapy is indicated.

Sex after bladder tour

Is sex possible after TUR of the bladder, this is a natural issue of interest to many patients. In most cases, after transurethral resection of the bladder, sexual activity is contraindicated for 1-2 months. This is due to the complications of the rehabilitation period and the ban on any physical activity. Compliance with this recommendation will accelerate the recovery period and the resumption of sexual activity.

Eating after a bladder tour

There are a number of recommendations regarding nutrition after TUR of the bladder, which must be observed for normal recovery of the body. The first few days after TUR, the patient is given an intravenous infusion of nutrients. Immediately after the operation, it is contraindicated to drink, water is only allowed from the second day. After this, the patient is prescribed a drinking diet to normalize the emptying of the bladder. During this period it is necessary to exclude such products from the diet:

• Salty and spicy.
• Fried and fatty.
• Filled broths.
• Good pastries.
• Carbonated and alcoholic drinks.
• Products with preservatives or artificial additives.

Once the intestinal peristalsis is restored, dietary fat-free meals are added to the diet. A fractional power regime is shown, that is, at regular intervals and in small portions.

Broths with mashed meat, vegetables, fish are allowed. You can eat boiled porridge, steam cutlets and boiled meat. The menu should be fresh vegetables, fruits and berries, but not sour. Since the second week, strict restrictions on nutrition are removed, and the diet can be returned to a preoperative form.

[36], [37],

Diet after bladder tour

For effective recovery, a special diet after TUR of the bladder is shown. Therapeutic diet excludes products with irritating effect on the mucosa of the operated organ. The first few days after surgery, the patient is fed by intravenous injection. From the second day you can consume water. From the third day, diet-free meals are allowed: boiled porridges on water and without oil, chicken broth, cottage cheese. On the fifth day in the diet, you can enter meat, steamed, baked vegetables.

Recommended products:

• Low-fat varieties of fish and meat.
• Kashi.
• Fresh, boiled or baked vegetables (except cabbage, tomato, radish, sorrel, onion and garlic).
• Sour milk products and milk.
• Fresh sweet fruits and berries.

Prohibited products:

• Spicy dishes, spices and condiments.
• Marinades and pickles.
• Filled broths.
• Fried, fatty, smoked.
• Alcohol.
• Strong tea or coffee.
• Good pastries and sweets.

Be sure to adhere to the drinking regime - to consume at least two liters of liquid per day. This is necessary to reduce the aggressive action of uric acid and the washing out of bacteria. Recommended herbal teas, cranberry or cowberry mors, unsweetened and not strong green or black tea, as well as pure drinking or mineral water without gas.

In addition to diet, after transurethral resection, it is necessary to consult regularly with a doctor and undergo follow-up examinations. This is necessary to evaluate the process of recovery of the operated area and timely detection of recurrences of the disease that caused the operation.

If after discharge from the hospital the following symptoms appear, you should immediately seek medical help:

• Obstructed urination or inability to exercise it.
• Pain, burning, frequent urge to the toilet, the presence of blood in urine for longer than 3-5 days after surgery.
• Symptoms of infection, fever, chills.
• Painful sensations that do not go away after taking medications for relief of discomfort.
• Attacks of nausea and vomiting.
• Violation of libido.

TUR of the bladder is an effective diagnostic and therapeutic method. But, if the above symptoms have appeared, the patient is given additional examinations. As a rule, this is cystoscopy, magnetic resonance imaging of pelvic organs and a complex of laboratory studies.