44
Surgery for
Bladder Tumours
This leaflet will help you understand your
operation and the care you will receive.
Please ask a nurse or doctor anything that
you do not understand or are unsure about.
Your bladder
The bladder is a hollow muscular balloon-like
organ that connects and stores urine. It is
situated in the lower part of the abdomen.
Urine consists of water and waste products not
needed by the body.
The two kidneys produce urine which is
carried to the bladder by ureters. The bladder
then stores the urine until full enough to empty
it through a tube called the urethra, which
expels urine from the body. In women, the
urethra is a very short tube immediately in
front of the vagina (birth canal). In men, the
tube is a longer one that passes through the
prostate gland and along the penis.
These include:
•
Blood Tests
•
CT scan
A special scan where
contrast is injected to check your
kidneys, ureters and bladder
•
Ultra Sound Scan Another type of
scan to look at the kidneys and bladder
•
Flexible Cystoscopy This allows the
nurse or doctor to look inside the
bladder
In one or more of the above tests, the results
have shown that there is an abnormal area in
the bladder that could be a bladder tumour.
Tumours of the bladder are almost always a
form of cancer, but the severity of the disease
varies widely. Tumours are also called a
variety of other names, such as warts, polpys
or growths.
In order to treat your condition, the nurse or
doctor has requested that you come into
hospital so that under an anaesthetic, the
bladder can be more closely examined and the
abnormal tissue removed.
Before your operation
Your condition
The commonest symptom is blood in the urine.
This usually occurs suddenly and is generally
not painful. Your GP will then refer you to the
specialist doctor or nurse at the hospital, who
will have arranged for you to have some or all
of a variety of tests.
Hopefully you will have been able to attend the
pre assessment clinic during the weeks prior
to your operation. If not, your documentation
and investigations will be performed on the
day of your admission to hospital.
These will include:
•
A urine sample to check that you have
no infection
•
Blood samples
After the operation
•
ECG (heart tracing)
•
Weight
When the operation is over, you will have your
blood pressure, pulse and breathing checked
regularly by the nurse.
•
Temperature,
pressure
•
Skin swabs
pulse
and
blood
You will be asked to sign a consent form. At
any stage please feel free to ask any
questions or express any fears that you have.
The nurse will inform you when to stop eating
and drinking before your operation. This will
vary according to whether your operation is in
the morning or afternoon.
If the anaesthetist has requested it, you will be
given a pre-medication. After you have
received this, you will be asked to remain on
your bed as you may feel sleepy.
You will be taken to theatre reception by a
nurse and a theatre porter. The theatre nurse
will check you details and escort you into the
anaesthetic room.
The operation
A rod-like instrument (a cystoscope) is passed
up the urethra and into your baldder. The
abnormal tissue can be removed and the area
cauterized using a mild electrical current to
prevent excessive bleeding. In this way one or
more tumours can be treated at the same
time.
An advantage of surgery through the urethra is
that there is no external wound, enabling you
to move around more quickly and easily after
your surgery.
All the tissue removed from the bladder is sent
to the laboratory for examination. This
provides information about the nature of the
tumour on which the multidisciplinary team will
base their decision about the future
management of your condition.
You will have a drip running into a vein in your
arm which will maintain your body fluids until
you are eating and drinking again.
There may be a flexible rubber tube (a
catheter) going up the urethra into your
bladder to drain away urine and blood. There
may also be an irrigation solution running
through the catheter to flush out blood from
the bladder. The irrigation will be stopped
when the bleeding stops. This may take a day
or so. A drainage bag is attached to the
catheter and you may find that the fluid
draining looks very bloodstained. This is
normal.
If you start to feel uncomfortable, as if you
urgently need to pass urine, the catheter may
be blocked and you need to tell the nurse
straight away so that the blockage can be
relieved.
A relative or friend is welcome to visit in the
evening.
After the operation, you can usually get out of
bed and walk around. You should be able to
eat and drink normally. You may seem a little
tired, so it is advisable to have plenty of rest
during the next few days.
The catheter, if inserted during your operation,
will be removed when your urine is pale pink in
colour. In order to make sure your urine clears
quickly, you should drink one or two glasses of
fluid every hour.
If this is the first time you have undergone
surgery to a bladder tumour your doctor may
recommend that a liquid chemical called
Mitomycin is put into the bladder, via the
catheter, just before your catheter is removed.
This chemical has been shown to help cut
down the chance of you getting further bladder
tumours. It is very rare for this single treatment
to cause any problems whatsoever.
Going home
You should be allowed home after your
catheter has been removed. This depends on
certain factors:
•
Whether your urine is clear
•
Whether you pass urine with good
control and are emptying your bladder
completely. This may be checked on
the ward using a portable scanner
•
Whether
you
temperature
have
a
raised
What are the causes of bladder
cancer?
The causes of cancer of the blader are largely
unknown, but research is going on all the time
into possible causes of the disease.
However, a number of factors are known to
increase the risk. Tobacco smoking is the
commonest known risk factor. Continued
smoking will increase the risk of further
bladder cancers in the future.
When will I get my results?
You will be given an outpatient appointment to
see the doctor or nurse approximately 2 weeks
after you have been discharged from the ward.
This is to allow the pathologist time to examine
your tumour under a microscope and for the
multidisciplinary team to discuss the results
and decide on future management of your
condition.
Will I need further treatment?
Most bladder cancers are confined to the
surface of the bladder. Usually all that is
needed is regular check ups with a flexible
cystoscope in the outpatient department. The
first check will be about 3 months after your
bladder surgery.
These tumours can recur so it is vital that you
attend for regular check ups for as long as
your doctor advises. This may be for the rest
of your life.
Occassionally the laboratory results show a
more active cancer or that the cancer has
started to spread deeper into the bladder
muscle wall. In these situations other
treatments may be needed. If this were to be
the case your doctor would discuss these in
detail with you when you return to clinic for the
results.
Discharge advice
To help you following your stay in hospital, this
leaflet has been written by the medical and
nursing staff as a guide towards a healthy
recovery.
At home
You probably have many questions about your
life and health after the operation. Here is
some advice to aid your recovery.
What if I see blood in my urine?
It is quite normal to see a little blood in your
urine for up to 4-6 weeks after your surgery.
As with any wound, scabs form and eventually
drop off causing minor bleeding. If this
happens, make sure you drink plenty of fluids
to flush and dilute the blood present.
If the bleeding is very heavy and persists for
more than 48 hours, then you must contact
your own GP.
You may continue to pass urine rather
frequently for a time. This should gradually
improve over the next five to six weeks.
If you experience increasing frequency of
urination, pain or discolouration of the urine or
have a temperature, you may have a urine
infection. Please contact your GP if symptoms
persist. If you were prescribed antibiotics on
discharge, please complete the course.
What exercise can I do?
Strenuous exercise, i.e gardening, decorating,
heavy lifting, golf, dancing should be avoided
for two weeks. You can then increase your
exercise so that by the end of four weeks you
are back to normal.
Walking and swimming are beneficial and may
be undertaken immediately.
You may drive short distances as soon as you
feel comfortable. Driving long distances should
be avoided for two weeks.
Will it affect my sex life?
Sexual activity can be resumed at your own
discretion.
When will I be able to work?
This depends on the type of work you do, but
as a rough guide, light jobs may be resumed
after 1-2 weeks. Heavy jobs should be avoided
for 4 weeks
Your GP will advise you.
General things to remember
•
If you have been given antibiotics,
make sure you complete the course
•
If you are unsure about the tablets you
have been given, contact your GP for
advice
•
Do not strain to pass stools. If you
become constipated contact your GP
•
If the blood in your urine increase and
you are worried, contact your GP
We hope you have found this information useful.
If you have any questions, or are worried about
anything, please speak to your GP or contact
Barnes Ward at Chesterfield Royal Hospital on
01246 512452.
Surgery for Bladder Tumours
Version 2
© Chesterfield Royal Hospital NHS Foundation Trust
Reviewed Date: April 2015
Next Planned Reviewed Date: April 2017
Surgical Division