Transurethral Resection of Bladder Tumor (TURBT)
Transurethral Resection of Bladder Tumor, or TURBT, is a procedure that allows your surgeon to biopsy or remove a tumor from the inside of your bladder while leaving the bladder intact. Because the procedure goes through the urethra, no incisions are necessary.
TURBT is typically done to diagnose and treat early-stage bladder cancer simultaneously. During a bladder tumor biopsy and resection procedure, a doctor employs a rigid instrument called a resectoscope, which is inserted into the bladder through the urethra. This transurethral approach eliminates the need for any incisions.
Using the resectoscope, the medical professional will skillfully remove the tumor, and the extracted tissue will be sent to a pathology lab for examination. Subsequently, any remaining cancer cells in the area will be targeted for destruction through the application of electric current, achieved by a process known as fulguration or cauterization.
In some cases, the doctor may opt to introduce a specific type of chemotherapy medication into the bladder using the scope. This method referred to as intravesical chemotherapy, involves periodic treatments to address the condition, and it might be recommended as maintenance therapy for a certain duration.
Radical cystectomy is a surgical procedure to remove the urinary bladder. In men, this typically includes removal of the prostate and seminal vessels. In women, radical cystectomy usually includes the removal of the uterus, ovaries, fallopian tubes, and part of the vagina.
After bladder removal, your surgeon must create a new way for your body to store and excrete urine. This is called urinary diversion. There are various types of urinary diversions, such as:
- Ileal Conduit - a type of urinary tract reconstruction that uses a piece of the small intestine (ileum) to create a tube (conduit) as an alternative incontinent pathway for urine to exit the body. The ureters are connected to the conduit, urine drains into the conduit and passes out of the body through a hole in the wall of the abdomen (stoma), filling a pouch worn underneath clothing. A stoma does not contain nerve endings, so it is not painful.
- Indiana Pouch (Continent Urinary Reservoir) - A type of urinary diversion where the surgeon uses a piece of the intestines to create a pouch (reservoir) inside the abdomen. Like the ileal conduit, the ureters are attached to the reservoir and a stoma inside the abdominal wall. The reservoir stores urine, which is drained by inserting a catheter into the stoma.
- Studer Pouch (Neobladder Reconstruction) - A type of urinary diversion involving the reshaping of a portion of the intestines into a spherical bladder that is then placed into the same location as the original bladder and attached to the ureters and urethra. The neobladder has the same capacity as a normal bladder, but a catheter may need to be used to drain it completely.
Bacillus Calmette-Guerin (BCG)
Bacillus Calmette-Guerin is an immunotherapy that uses an attenuated live strain of Mycobacterium Bovis as a therapy for and prophylaxis against recurrent tumors of non-invasive urothelial bladder cancer.
Mitomycin is a cytotox antibiotic given to inhibit DNA synthesis in bladder cancer cells. Sodium Bicarbonate, which is used to raise the pH of serum and urine, may be used orally in combination with mitomycin to buffer urine pH.
Bladder-sparing treatments aim to avoid cystectomy by a multidisciplinary approach to cancer therapy.