Transurethral resection of the bladder: postoperative period and recovery

The procedure for assessing the condition of bladder tissues or taking them for biopsy is transurethral resection. Let's consider its features and indications for implementation.

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

TUR of the bladder is a high-tech endovideoscopic operation. This type of surgical intervention differs significantly from open surgery, as it does not require external incisions and is performed using an endoscope.

The main advantages of TUR over open resection:

• Minimal tissue trauma.
• Minimum blood loss during surgery.
• Minimal risk of infectious complications.
• Easy and fast recovery period with a low probability of developing postoperative complications.
• There is no risk of seam opening.

In terms of its effectiveness, transurethral resection is not inferior to open surgery. Most often, it is performed for 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 over other surgical treatment methods is the lack of need to violate the integrity of the skin and soft tissues. The entire procedure is performed using thin instruments inserted into the urethra. Let's consider the main indications for transurethral resection of the bladder:

• Diagnosis and treatment of tumors.
• Biopsy of organ tissue.
• Intense manifestation of prostate adenoma.
• Benign prostatic hyperplasia.
• Difficulty removing urine from the body.
• Frequent urination at night.
• Bacterial or viral infections of the genitourinary system in men.
• A feeling of a small amount of fluid in the bladder.
• Complications after incomplete or incorrectly prescribed early treatment.
• Kidney damage (mechanical, biological) and impairment of their functions.
• Uncontrolled urination caused by damage to the bladder.
• Bleeding from the urethra.
• Stones in the urinary system.

In addition to indications, surgical intervention has a number of contraindications. TUR is not performed in case of exacerbation of chronic diseases of the cardiovascular and excretory systems, diabetes, as well as in case of pathologies of the pelvic joints that limit the surgical field.

TUR for bladder tumor

A surgical endoscopic procedure aimed at diagnosing and treating tumors is TUR. In case of bladder tumor, transurethral resection is necessary for:

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

Today, TUR for bladder tumors is the best method for treating early stages of malignant processes. Resection is especially effective for exophytic tumors that grow into the lumen of the organ.

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TUR for bladder cancer

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

A tour for bladder cancer is performed under the following conditions:

• Early stages of malignancy. Cancer has affected only the mucous membrane, muscles are not affected.
• The size of the neoplasm does not exceed 5 cm.
• The lymph nodes are not affected by metastases.
• The urethra and the urinary sphincter area are not damaged by the disease.

Transurethral resection has specific goals:

• Tumor removal.
• Study of neoplasm.
• Study of the inner lining of the bladder and identification of associated pathologies.
• Taking tissue samples for biopsy.

As a rule, cancer begins as a superficial tumor. The first sign of pathology is 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 greater seriousness of the disease.

Very often, bladder tumors are accompanied by additional pathologies of the urinary system. TUR allows you to take a piece of tissue for biopsy from several areas of the organ and identify pathological processes. The advantage of this diagnostic and therapeutic method is that it does not cause such tissue trauma as open methods. After the procedure, a small wound remains, which heals within 4-6 weeks. The recovery period is quick and almost painless.

TUR for leukoplakia of the bladder

An extremely rare disease that develops against the background of a chronic infection and most often in women is leukoplakia. TUR for 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 flat epithelium. Over time, this leads to keratinization of the newly formed layer. Coarsened tissues disrupt the normal functioning of the organ. The disorder is considered a precancerous condition, since there is a risk of the appearance of an oncogenic type of plaques.

The main cause of the disease is chronic genitourinary infections. Most often, leukoplakia occurs due to trichomonads, gonococci, ureaplasmosis, chlamydia and other pathogenic microorganisms.

There are three types of leukoplakia of the bladder:

• Flat - a grey or white coating with clear contours forms on healthy tissue.
• Verrucous - repeats the flat shape, but the changes include nodules that overlap each other.
• Erosive - small ulcerative lesions are added to the symptoms of the two above-mentioned forms.

The most dangerous are the erosive and warty 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 worsens at night.
• Aching and pulling pain in the lower abdomen with a full bladder.
• Urination disorders: incomplete emptying, burning, interruption of the stream.
• Rapid fatigue.
• General weakness.

The symptoms of the disease are often confused with cystitis. Various methods are used for diagnosis, most often: laboratory tests, cystoscopy, ultrasound of the pelvic organs, biopsy of the bladder walls. A comprehensive diagnostic approach allows for a correct diagnosis and determination of the affected area.

Treatment is carried out by both medicinal and surgical methods. Conservative therapy is carried out using instillations with a solution of sodium chloride, heparin, lidocaine. The operation is carried out in case of a large area of tissue damage and if there is a suspicion of malignancy of the process.

Transurethral resection for leukoplakia involves removing pathological areas of the mucosa using a special loop. Access to the affected areas is through the urethra using a cystoscope. After this procedure, the integrity of the bladder walls is preserved. Another treatment option for the disease is laser coagulation of the mucosa and laser ablation. The recovery period after TUR is quick, the risk of complications or relapses of the disorder is minimal.

Preparation

Transurethral resection of the bladder is a surgical procedure that requires special preparation by the patient.

• 3-10 days before endovideoscopy, it is necessary to pass a full range of laboratory (blood, urine) and instrumental examinations. An electrocardiogram and chest X-ray are mandatory.
• Before TUR, the patient undergoes a consultation with a therapist and anesthesiologist. The general condition, presence of chronic diseases and possible risks of the operation are assessed. The type of anesthesia is selected.
• In the evening before the resection, a cleansing enema is given and the surgical field is cleaned. During this period, you cannot eat.
• In the morning before TUR, the patient is given antibiotics to prevent infection and sent for surgery.

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

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Technique Bladder TUR

TUR is a minimally invasive surgical intervention that is less aggressive than open adenometomy. The technique for performing transurethral resection of the bladder consists of:

• After preparation for the procedure, the patient is placed on his back on the operating table with his legs spread and bent at the knees.
• A cystoresectoscope is inserted into the bladder through the urethra. The organ is filled with a sterile solution. All surgical manipulations are performed under the supervision of a doctor, and the image is displayed on a monitor.
• After examining the organ, tissue is taken for biopsy or tumor formation is removed using a cystoresectoscope. The bed of removed tissue is coagulated to prevent bleeding.
• The obtained 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 to irrigate the organ with chemotherapy drugs to prevent relapses of the disease.

Transurethral resection can be performed under either general or spinal anesthesia. If the first option of anesthesia is chosen, the patient is unconscious during the entire operation. With spinal anesthesia, the lower half of the body is anesthetized and the patient is conscious. The choice of anesthesia depends on many factors, especially the patient's condition, the planned scope of the intervention and the indications for its implementation.

Bladder neck tour

A fairly common disease of the genitourinary system in men is sclerosis of the neck of the bladder. Due to 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 the 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 performed.

TUR of the bladder neck is a surgical method of treating the disease. The operation is performed without violating the integrity of the tissues. The main goal of the procedure is resection of scars on the neck that narrow the lumen. After transurethral treatment, the patient is prescribed a course of antibiotics. In some cases, after 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 for implementation. Let's consider them:

• Serious pathologies of the cardiovascular system.
• Renal or hepatic insufficiency.
• Blood clotting disorder.
• Infectious diseases.
• Cold, acute respiratory viral infection.
• Infectious lesions of the urinary system.

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

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Consequences after the procedure

Some patients experience certain consequences after the transurethral resection procedure. The first days after the operation, severe painful sensations in the bladder and urethra persist. Such an early postoperative period may be accompanied by blood in 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 accompanied by symptoms such as: an increase in body temperature above 37 °C, dark-colored urine with an unpleasant odor, blood clots in the urine, then you should consult a doctor.

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

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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 the following problems:

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

In addition to the above, cystitis is a fairly common complication. This occurs due to a violation of the contractile function of the bladder. Cystitis is characterized by pain when urinating, and in some cases, problems with its implementation. To eliminate it, you should seek medical help.

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Blood in urine after bladder tour

Such a symptom as blood in the urine after TUR of the bladder occurs in many patients. As a rule, macrohematuria is a temporary consequence of the operation. Surgical intervention leads to the fact that urine acquires a pinkish or orange-red tint. It is also possible to release blood clots. This disorder goes away on its own 2-4 days after the procedure.

If blood in the urine persists for a long period of time after TUR, this indicates the development of serious complications. Hematuria may be a sign of serious injuries to the bladder mucosa, signal a chronic form of cystitis or inflammation of the walls of the urethra, i.e. urethritis. For diagnosis and treatment of the disease, you should contact your doctor.

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Pain after bladder tour

Many patients face such a problem as pain after TUR of the bladder. First of all, discomfort is associated with a recent surgical intervention, during which tissue was taken for biopsy or the removal of detected neoplasms was performed.

The pain is temporary. If the pain syndrome is quite acute and intense, then painkillers are prescribed, which make the recovery period more comfortable. Symptoms in which the pain is accompanied by problems with urination, blood clots in the urine and other pathological signs should alert you. In this case, you should immediately seek medical help.

Bleeding after bladder tour

The most common complication is bleeding after TUR of the bladder. As a rule, this symptom is temporary and goes away on its own within a few days after the operation. If the bleeding is intense, then it may be necessary to wash the bladder, after which the patient is advised to stay in bed.

Bleeding after transurethral resection may be due to bladder perforation. This complication is the second most common after TUR after bleeding. Additional surgery is required to eliminate it.

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Cystitis after bladder tour

Cystitis often develops after surgery on the genitourinary system. This complication often occurs after TUR of the bladder. Inflammation of the mucous membranes of the organ indicates an infectious infection. This may be streptococcus, staphylococcus, proteus, E. coli and other pathogens.

Cystitis may 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 burning during urination. The urine may contain blood. Drug therapy is indicated to eliminate postoperative cystitis.

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Pseudomonas aeruginosa after bladder tour

Pseudomonas aeruginosa occupies a special place among the causative agents of urinary tract infections. After TUR of the bladder, it is extremely rare and indicates postoperative problems. This harmful microorganism is characterized by increased resistance to most antimicrobial drugs and can cause serious infectious complications from the genitourinary system.

• Pseudomonas aeruginosa is capable of synthesizing a water-soluble phenazine pigment, pyocyanin. It colors the nutrient medium blue-green. This significantly simplifies the identification of gram-negative bacteria.
• The source of infection may be poorly disinfected devices and equipment, solutions or medications that contain an insufficiently effective bacteriostatic agent.
• Infection is possible with congenital defects of the genital organs, frequent catheterization, and prostatectomy.

Pseudomonas aeruginosa after a tour of the bladder is dangerous because it can last for months, and sometimes years, causing kidney dysfunction. Asymptomatic urogenital infection turns into a generalized form, which is characterized by sepsis, from transient episodes of fever to septic shock.

Laboratory bacterioscopic diagnostics and various serological tests are used to diagnose the infection. Peptide antibiotics (polymyxins), broad-spectrum penicillins, and aminoglycosides are used for treatment. Immunoprophylaxis of Pseudomonas aeruginosa is also indicated.

Care after the procedure

Transurethral resection of the bladder, like any surgical intervention, requires a recovery period. Post-procedure care is divided into procedures performed in hospital and at home.

In the hospital:

• A catheter is inserted into the bladder to drain urine and left in overnight. Water can be injected into the bladder to flush out blood clots.
• The urine collection container should be below the level of the bladder.
• Immediately after the operation and until the next morning, bed rest is recommended.
• During the first days after the procedure, you must perform the exercises prescribed by your doctor.

At home:

• The catheter insertion area should be cleaned regularly. You can use soap and water for this.
• To cleanse the bladder, you should drink as much liquid as possible.
• Heavy or strenuous work is contraindicated for 1-1.5 months after surgery.
• Sexual activity is prohibited for 1-2 months after TUR.
• You should avoid alcohol, spicy foods and caffeine.

With proper care after the procedure, recovery takes about three weeks. Painful sensations and frequent urination persist for 3-5 days, which gradually disappear.

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How to behave after a bladder tour?

Many patients who have undergone surgery on the genitourinary system do not know how to behave afterwards. TUR of the bladder requires 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, sharp pain and burning in the urethra, clear urge to go to the toilet, small volumes of urination, and the presence of impurities or blood clots in the urine may appear. Such phenomena pass in 7-14 days.

Immediately after transurethral resection, the patient is prescribed bed rest and dynamic observation by a 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

The time after any operation is very important. The postoperative period after TUR of the bladder largely depends on the indications for the surgical intervention. The patient is prescribed drug therapy, a special diet and a course of physiotherapy.

During rehabilitation, it is contraindicated to eat spicy or sour foods, alcohol and drinks with caffeine. If these recommendations are not followed, the composition of urine may change and it may irritate the fresh wound. The first time after endovideoscopy, you should drink a lot of fluids. This is necessary for effective bladder lavage, preventing infectious infections and constipation.

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

Chemotherapy after bladder tour

If transurethral resection is prescribed for malignant neoplasms, then the patient is prescribed chemotherapy. After TUR of the bladder, it is necessary to prevent relapses of the disease or destroy metastases in other organs and tissues. Immediately after the operation, chemotherapy drugs are injected into the affected organ, and an irrigation system is installed to control the secretions from the bladder.

• If the malignant disease occurs at early stages, intravesical chemotherapy is used. This method is carried out 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. The therapy is carried out once a week for several months.

• In case of 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 administered both before and after TUR. Chemotherapy drugs can be administered in cycles. Most often, patients are prescribed a combination of Methotrexate, Vinblastine, Doxorubicin and Cisplatin. The drugs are administered intravesically, i.e. through a catheter, intra-arterially or endolymphatically.

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Recovery after bladder tour

After the surgical endoscopic procedure, the patient undergoes a rehabilitation course aimed at normalizing the body's functioning. Recovery after TUR of the bladder takes about 1-2 months. The speed 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 setting. Using an installed catheter, the bladder is continuously washed from blood or medications are administered. The patient is prescribed a course of antibiotics. A gentle diet and bed rest are also recommended. After 2-3 days, the patient is discharged home and prescribed a course of physiotherapy to speed up recovery after the operation.

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

Sex after bladder tour

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

Nutrition after bladder tour

There are a number of recommendations regarding nutrition after TUR of the bladder that must be followed for normal recovery of the body. The first few days after TUR, the patient is given intravenous infusions of nutrients. Immediately after the operation, drinking is contraindicated; water is allowed only from the second day. After this, the patient is prescribed a drinking diet to normalize emptying of the bladder. During this period, the following products must be excluded from the diet:

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

As soon as intestinal peristalsis is restored, dietary low-fat dishes are added to the diet. A fractional diet is recommended, that is, at certain intervals and in small portions.

Broths with mashed meat, vegetables, and fish are allowed. You can eat boiled porridge, steamed cutlets, and boiled meat. The menu should include fresh vegetables, fruits, and berries, but not sour ones. From the second week, strict restrictions regarding nutrition are lifted, and the diet can be returned to its pre-operative form.

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Diet after bladder tour

For effective recovery, a special diet is recommended after TUR of the bladder. The therapeutic diet excludes products with an irritating effect on the mucous membrane of the operated organ. The first few days after the operation, the patient eats with the help of intravenous injections. From the second day, you can drink water. From the third day, dietary low-fat dishes are allowed: porridge boiled in water and without oil, chicken broth, cottage cheese. On the fifth day, you can introduce steamed meat and baked vegetables into the diet.

Recommended products:

• Lean varieties of fish and meat.
• Porridge.
• Fresh, boiled or baked vegetables (except cabbage, tomatoes, radishes, sorrel, onions and garlic).
• Fermented milk products and milk.
• Fresh sweet fruits and berries.

Prohibited products:

• Spicy dishes, spices and seasonings.
• Marinades and pickles.
• Rich broths.
• Fried, fatty, smoked.
• Alcohol.
• Strong tea or coffee.
• Pastries and sweets.

It is essential to adhere to a drinking regimen – drink at least two liters of liquid per day. This is necessary to reduce the aggressive action of uric acid and wash out bacteria. Herbal teas, cranberry or lingonberry juice, unsweetened and weak green or black tea, as well as clean drinking or mineral water without gas are recommended.

In addition to diet, after transurethral resection it is necessary to regularly consult with a doctor and undergo control examinations. This is necessary to assess the recovery process of the operated area and timely detection of relapses of the disease that served as the reason for the operation.

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

• Difficulty urinating or inability to urinate.
• Pain, burning, frequent urge to urinate, presence of blood in the urine for longer than 3-5 days after surgery.
• Symptoms of an infectious infection include fever and chills.
• Painful sensations that do not go away after taking medications to relieve discomfort.
• Attacks of nausea and vomiting.
• Libido disorder.

TUR of the bladder is an effective diagnostic and therapeutic method. However, if the above symptoms appear, the patient is prescribed additional examinations. As a rule, this is cystoscopy, magnetic resonance imaging of the pelvic organs and a set of laboratory tests.