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Transurethral resection of the bladder is a complete surgical intervention, the purpose of which is to help with diagnosed cancer of the specified organ.
The technique has proven itself as an effective tool for eliminating superficial malignant neoplasms with localization in the urinary cavity. The plan is carried out with the help of a special device – a resectoscope.
As soon as a special loop of the tool covers the tumor along with its base, it will be possible to obtain biological samples of the neoplasm. They are then sent to the clinical laboratory for detailed study. Thanks to the cut-off sample, the laboratory assistant will be able to determine the specific type of neoplasm, as well as assess its resistance to various therapeutic options.
If it is confirmed that the risk of recurrence is very high, then it will be more effective to administer a number of chemotherapeutic drugs along with the main action. This will block the spread of the disease or completely extinguish its vigorous activity.
Features of the operation
Transurethral resection is often abbreviated simply to TUR. Manipulation is a productive tool only if a malignant tumor was diagnosed at an early stage of its development. The good news here is that the detection of a tumor only at the beginning of its development is a fairly common occurrence.
If a person is experiencing difficulty with urination, he will rarely put off solving such a delicate problem indefinitely. From this follows a completely logical explanation for the high percentage of early diagnosis of the lesion. Due to his own foresight, the victim will be able to protect the body from damage by the inflammatory process of surrounding still healthy tissues.
According to statistics, the representatives of the stronger sex are more susceptible to the development of bladder cancer than women. Such strange statistics are explained by the peculiarities of physiology. And most often the victims of such a deviation are Americans and residents of Europe.
It is believed that the transurethral approach is listed as a gentle alternative to a full-fledged surgical intervention. This happens due to the fact that to work with a resectoscope, you do not have to make additional cuts or punctures that violate the integrity of the skin.
Instead, everything will be done by a device that is equipped with a small camera. It is designed to visualize the inner walls and the process of neoplasm neutralization on the screen.
Advantages of the procedure
Many ordinary people are interested in the price of such an intervention format, but here it will not be possible to answer unambiguously. Each hospital has its own pricing policy. You will also have to take on additional costs for proper recovery in the postoperative phase.
But there is no confusion with the advantages of the technique, because all doctors confirm its positive qualities. The list of distinctive features of the method included:
- establishing not only an accurate diagnosis based on subsequent histology, but also determining the degree of damage to the pathology;
- determination of the stage of development of a malignant neoplasm;
- identifying the risks of penetration of tumor cells into the surrounding tissues and the muscle wall of the bladder itself;
- fixing the clinical prognosis;
- identification of factors that may indicate an increased likelihood of recurrence of the tumor in the same place;
- clarification of the localization of the lesion with a calculation of their number, specific size and configuration;
- final excision of the problem area.
To say for sure that TOUR will absolutely help is not an easy task. In their forecasts, experts will certainly take into account how much the malignant process has managed to affect the walls of the bladder.
Sometimes manipulation is needed in order to double-check the work of another urological surgeon, who could not completely cut off the tumor, not notice a small neoplasm in the neighborhood. The result of such imaging will be useful for monitoring the structure of the urethra.
If during the general clinical examination it suddenly turns out that the patient has a flat cancerous tumor, then it is better not to perform TUR. Even the initial phase of the disease will not help here. It will be much more effective to use a resectoscope if the neoplasm has grown into the cavity of the organ of the urinary system.
Preparatory stage
Before issuing a referral for a transurethral intervention, the doctor will send the ward to take related tests without fail. This allows you to identify previously undiscovered chronic diseases, information about which is not in the patient’s medical record.
During preparation, it will not do without an external examination, studying the complaints of the victim, questioning for the presence of congenital pathologies or poor heredity. At the same time, it is customary to carry out a traditional external examination in two ways, depending on the gender of the applicant:
- women examine the potential affected area through the vagina;
- men are examined through the rectal opening.
Such a superficial examination helps to establish the approximate diameter of the formation, as well as determine the stage of its progress.
If the seal was nevertheless found in the bladder area, then the victim is assigned to undergo a series of secondary tests of the differential type:
- biopsy of the extracted sample;
- urine cytology;
- clinical study of flushing from the area of the affected organ;
- cystoscopy;
- sciptigraphy of dynamic and statistical type;
- ultrasound examination of the bladder and surrounding organs.
Separately, the expediency of organizing the sowing of biological material from the urethra with transfer to a nutrient medium in the laboratory is considered.
Blood counts are also taken into account during a general analysis. With their help, it is possible to accurately determine the quantitative and qualitative value of platelets, red blood cells and the hemoglobin threshold.
If we are talking about a tumor of relatively modest dimensions, then often it chooses the location of the mucous membrane. Due to this, TUR can be carried out quickly and with minimal risk of possible negative consequences.
To prescribe a more effective format of care, doctors have introduced a special classification of all bladder neoplasms. Thanks to it, it is possible to quickly understand which preparation suits a particular patient best. But if the formation has grown very strongly, simultaneously damaging the internal organs located next to the bladder, then this aggravates the clinical picture. To the analyzes described above in the preparatory phase, they also add:
- magnetic resonance therapy;
- computed tomography;
- x-ray study.
You will have to come to terms with the fact that the operation must be postponed if biochemical analyzes have shown the presence of pathogenic pathogens of an infectious species. First, you will have to rid the genitourinary system of their presence, and then enjoy the privileges of the transurethral method.
To correct the situation, you will need to undergo a course of treatment with antimicrobial drugs and antibiotics. The urologist appoints them, based on the individual characteristics of the organism of the ward. That is why it is forbidden to change the dosage of drugs, the schedule of administration, to try to change the dosage on your own.
People with chronic illnesses deserve special attention at the preparatory stage. They will have to consult with their doctor in advance about temporarily refusing to take their usual drugs if they are working on blood thinning. But without the approval of the doctor, it is strictly forbidden to quit the course of treatment on your own.
The last meal should be no later than the evening before. And on the day of the operation, you will need to give up breakfast and even drinking drinks. If you ignore this rule, you can run into the risks of improper action of anesthesia.
It would be useful to conduct an allergic test in advance for the composition of anesthesia, if the person has not previously been exposed to it. This will prevent sudden anaphylactic shock from developing.
How the operation is performed
The approximate time spent on the implementation of the plan is determined individually in each case. In the most successful scenario, everything will end in 15 minutes, but this happens only with convenient access to the tumor and its small size.
If we are talking about a large growth that is difficult to reach, or it has already grown into the cavity, then the procedure can take almost an hour. As soon as the anesthesia takes effect, it is allowed to proceed to the surgical part of the work.
First, the cystoscope is passed through the urethra straight into the cavity of the bladder. Then it is required to carry out the prevention of the spread of possible infection. To do this, it is necessary to irrigate the mucous membranes and the smooth muscle internal structure with a sterile liquid.
As soon as the solution fills the cavity, this will improve the visualization of the surgical field by an order of magnitude to search for a malignant tumor. The device itself for helping the victim is equipped with a small loop, which is aimed at removing the process and the affected layers located next to it.
As soon as the tumor is cut off, the wound surface is necessarily cauterized to exclude the possibility of the spread of the inflammatory process. The same mechanism is used to stop bleeding.
After the tumor is excised, it is immediately removed from the cavity. But this option is only suitable for small growths. If a giant tumor is found inside, then it will be more efficient to first cut it into several parts in order to simplify the subsequent evacuation.
Postoperative drainage involves the placement of a catheter for approximately XNUMX hours. And all the tissues collected during the operation are poisoned to the laboratory for a detailed study according to the histological scheme.
As soon as the TUR is completed, the patient will have to come to terms with the fact that a cauterized, but still wound will remain inside the bubble. As soon as urine reaches it, the mechanism of surface irritation will start, due to which the functionality of emptying the bladder may change somewhat. Most often we are talking about a strong urge to urinate.
But as you recover, the negative symptoms go away on their own. There is an improvement in the clinical picture within approximately one month. Moreover, it is quite normal if for this period the victim, along with urine, will have blood in small quantities.
Expected and Unnatural Side Effects
Despite the effectiveness of the method, it is still a radical approach, albeit in a sparing mode. Against this background, the development of various side effects is a common thing.
Their number and degree of severity depends on the master of the doctor who performed the operation, as well as the characteristics of the behavior of the body of the victim himself. Often the consequences of manipulation cover:
- pain sensations;
- discomfort in the bladder;
- discomfort in the urethra;
- hematuria;
- rezi;
- burning on emptying.
To reduce such manifestations, experts recommend consuming more fluids. It should be pure still water, and not irritating drinks like alcohol.
Due to the risk of heavy bleeding in the first days of the postoperative period, the medical staff will monitor the victim especially vigilantly.
Separately, you need to prepare for the fact that the penetration of an infectious agent into the cavity of the bladder is a frequent occurrence. Sometimes this phenomenon takes place even after careful sterilization of all instruments.
This may be due to the fact that pathogens entered the bladder itself through the ureter, or the cavity was poorly irrigated with bactericidal agents at the beginning of the operation. Because of this, it will be easier to play it safe and additionally carry out parenteral administration of an antibacterial composition.
A prerequisite for the positive dynamics of recovery is the observance of personal hygiene rules, as well as adherence to preventive precepts.
Since after the removal of the lesion, a hole remains at the site of the cut, albeit a small one, the bubble will have to be given time for the wound to heal. At this time, doctors install a special device – a cystostomy. It will allow you to quickly and correctly restore the integrity of the walls by dragging the main urination functionality onto itself.
After successful completion of the inpatient stage of treatment, the victim will be sent home. But this does not mean that he can already return to the usual rhythm of life. You will first need to complete a full program of outpatient therapy.
If a person feels worse already at home, then this is an occasion to seek help from the attending physician. The main warning signs usually cover a sharp increase in body temperature, as well as pain in the lower abdomen. Sometimes they can give to the lumbar region, preventing you from falling asleep during the day.
Blood clots in the urine are also a cause for concern, as is a decrease in the usual volume of urine while maintaining the standard drinking regimen.
About a week after the operation, the results of the biopsy are provided to the doctor. With their help, it will be possible to establish whether the neoplasm was really malignant. If so, then the patient cannot do without chemotherapy. With its help, it will be possible to exclude the likelihood of relapse with the spread of metastases to neighboring tissues.
Postoperative complications
Even the well-coordinated work of medical personnel cannot fully guarantee the success of the intervention. There is always a minimum percentage of the development of events according to a bad scenario, which provides for the detection of complications in the future or even a fatal outcome.
The primary source for this is not only the failure of the urinary system, but also the destabilization of the cardiovascular activity, the lower respiratory tract. If a patient is found to have bleeding, then regular washings of the ureters with drugs with a disinfectant spectrum of action cannot be dispensed with.
Violation of the integrity of the bladder is also among the most common complications after TURP. Only long-term catheterization with the obligatory observance of bed rest will help here.
The horizontal position in the first few days after the discovery of the consequences is the key to a successful recovery.
Particular attention deserves the prevention of contamination of the organs of the urinary system with viruses, protozoa and other pathogens. For this, a person is prescribed a course with antimicrobials in reduced doses.
A well-conducted analysis for the detection of latent infections will allow you to choose the optimal medication. He will also be able to determine whether the detected type of bacteria is resistant to a particular active substance.
To prevent all of the above, you should choose only a qualified surgeon for the operation, as well as regularly go for preventive examinations for the entire period of rehabilitation after discharge.