Widget Image

I receive in Florence, Prato and Milan

Florence
Matteotti Medical Group
Viale Giacomo Matteotti, 42
50132 - Florence (FI)
Telephone: 055 570224
Florence Castello
Villa Donatello
Via Attilio Ragionieri, 101
50019 - Sesto Fiorentino (FI)
Telephone: 055 50975
Prato
Studi Medici Life
Viale della Repubblica, 141
59100 - Prato (PO)
Telephone: 0574 583501
Milan
Columbus Clinic Center
Via Michelangelo Buonarroti, 48
20145 - Milan (MI)
Telephone: 02 480 801

UROLOGICAL SURGERY

Endoscopic removal
of bladder cancer
(TURV)

SURGERY

Endoscopic removal of bladder cancer (TURV)

The identification of a bladder tumor implies the need for a transurethral endoscopic resection

(i.e. through the urethra).

After anesthesia, the patient is placed in the lithotomy position with the perineum perpendicular to the table top. A resector is then introduced into the bladder under direct vision, to remove the tumor lesion. Once the resection and haemostasis have been completed, the resected tissue is extracted from the bladder and sent to the Pathological Anatomy Department for histological examination. A bladder catheter is then placed (which will be removed later on the basis of the instructions provided by the operator, generally within 4-5 days). Always at the operator’s discretion, an intravesical instillation of a chemotherapeutic substance may be performed, which can act immediately on the bladder mucosa in such a way as to reduce the risk of recurrence of the tumor disease and to reduce the need for subsequent intravesical instillations on an outpatient basis.

Like any surgery, endoscopic resection of bladder cancer (TURV) is also associated, albeit in a limited percentage, with complications.
The most frequent complications are observed during the operation itself. These include the finding of previously undiagnosed conditions such as stricture of the external urethral meatus and/or stricture of the urethra. These pathologies, of a benign nature, often require immediate additional treatment, not previously foreseen as they can prevent the execution of the TURV surgery itself, preventing access to the bladder. The need for additional maneuvers can prolong the operation and/or the post-operative convalescence. In some rare cases (1%), a perforation of the bladder wall with extravasation of lavage fluid or urine into the abdominal cavity is observed during surgery. In almost all cases of perforation, conservative therapy is opted for, which involves maintaining the bladder catheter and administering diuretic drugs. In very rare cases, percutaneous or surgical drainage of the extravasated liquid and the simultaneous surgical repair of the continuous solution of the bladder wall are necessary.
In the postoperative period, the most frequent complication is bleeding. After TURV surgery, the presence of a small amount of blood in the urine (haematuria) is normal and is due to the surgery itself which involves the removal of the bladder neoformation. In some patients, the presence of hematuria is greater so it is necessary to maintain the bladder catheter with continuous lavage of the bladder. However, in some very rare cases the profusion of blood is excessive and an endoscopic revision is necessary, i.e. a new surgery, again through the urethra, aimed at stopping the source of bleeding. Bleeding can also occur about 10-15 days after surgery, typically due to the fall of internal eschars. In most cases, there is only the reappearance of hematuria (blood in the urine) for a few days, without further problems. In some rare cases, the clots can block the flow of urine, making it necessary to reposition the bladder catheter and possibly to wash the bladder.

Starting a few hours after the operation, in case of spinal anesthesia, the patient resumes drinking and eating gradually. In the case of deep sedation or general anesthesia, it will be the discretion of the anesthesiologist to establish when the patient can resume fluid and solid intake. The patient is made to get out of bed on the first day and, compatibly with the natural recovery of his energies, he is mobilized to an ever greater extent. It is good that the patient, as soon as possible, starts walking in the corridor to favor the recovery of normal circulation, to avoid the formation of thrombi in the veins of the lower limbs and to facilitate the resumption of intestinal activity. Antibiotic prophylaxis, administered before the start of surgery (to prevent infections) together with gastroprotection, is prolonged only if deemed necessary. The prophylaxis of thromboembolic pathology with low molecular weight heparin is implemented starting from the evening of the operation and subsequently from 6-12 hours after its conclusion, prolonging its administration for a few days, on the basis of the operation and the characteristics of the patient. The bladder catheter, which is placed during the operation, is kept in place for a period usually ranging from 1 to 3 days (rarely longer), at the discretion of the operator.
Supply – You can gradually resume your usual diet; – it is advisable to drink about two liters of water a day until the urine no longer shows traces of blood. – Avoid the consumption of alcohol, coffee and potentially irritating spicy and hot foods for at least 7 days – It is particularly important to vary the diet by enriching it with cooked fruit and fresh fruit – such as kiwi – and vegetables, minestrone with raw oil, puddings, yoghurt, ice cream and still drink abundantly in order to facilitate the recovery of intestinal activity.Physical activity After being discharged from the hospital, physical activity can be resumed gradually and with common sense. However, excessive efforts must be avoided, such as lifting heavy objects or performing intense exercises (gym, golf, tennis, running), during the first 4 weeks following the operation. It is also important to avoid riding sports (bicycle, motorcycle, horse riding) during the first 4-8 weeks. After 4 weeks from the operation, practically all the activities carried out before the operation can be resumed, postponing only the saddle sports.Urinary tract infections They happen infrequently. They can manifest themselves in various ways (burning during or after urination, cloudy and foul-smelling urine, fever, etc.). In this case, it is advisable to perform a complete urine test and a urine culture with an antibiogram, to drink abundantly and urinate often, and to contact the attending physician for any appropriate antibiotic therapy.Blood in the urine It can occur due to small lesions caused by the catheter, or by the lysis of old clots that were present in the bladder. Urine may remain pink for 15 to 20 days after the catheter is removed. Plenty of hydration (drinking at least 1.5-2 liters of water per day) can help clear urine. Rarely it may happen that the patient is unable to urinate due to the presence of bladder clots that prevent urine from leaking, in this case it is important that he goes to the nearest Emergency Department.
The definitive histological examination defines the exact nature of the intravesical tumor pathology and above all provides precise information regarding its extension deep inside the bladder. Based on this extension, bladder cancer is defined as superficial or infiltrating, depending on whether it simply involves the inner layers (connective tissue) or outer layers (muscle tissue or serous tunic). Superficial and less aggressive bladder neoplasms do not require any additional therapy, but only vigilant surveillance by means of periodic cystoscopic and imaging (usually ultrasound) control. In some cases of more aggressive superficial bladder neoplasia, a course of periodic intravesical instillations of a drug with chemotherapy or immunotherapy (BCG) action may be indicated. The cycle of intravesical instillations has a minimum duration of 6 weeks and can last up to 3 years overall. The decision whether or not to carry out the intravesical indications is the responsibility of the referring Urologist specialist and is generally taken on the basis of the outcome of the histological examination relating to the removed neoplasm. It is sometimes indicated to perform an intravesical instillation of a chemotherapy drug in the first 24 hours following TURV surgery. It may also happen that, after a first endoscopic surgery, the patient may be a candidate for a second endoscopic surgery on the bladder (TURV 2nd look, or “second resection”) for a more complete remediation of the latter, either in a period of time immediately following the first surgery (after 4-6 weeks) or after a first cycle of intravesical instillations. In the most serious cases of neoplasm infiltrating the muscle wall, the current European guidelines recommend a demolitive surgery to remove the entire bladder (cystectomy) with the creation of urinary diversion necessary for the purpose of expelling urine outside. The decision to proceed with cystectomy and the most suitable type of urinary diversion must always arise from an in-depth discussion between the patient and the reference Urologist.
DO YOU BELIEVE YOU HAVE A PROBLEM?

Ask a question
to Dr. Cocci

You will receive a reply from Dr. Cocci privately to your e-mail address, and you will be able to evaluate without obligation whether to book the specialist visit.



    Book a visit or a consultation

    I receive visits at the structures in Milan, Florence and Prato.

    Book the first visit or a specialist consultation at the office closest to you.

    For patients residing abroad, it is also possible to request a first remote consultation, using the contact form.

    Florence | Matteotti Medical Group

    Viale Giacomo Matteotti, 42
    50132 – Florence (FI)
    Telephone: 055 570224

    Florence Castello | Villa Donatello

    Via Attilio Ragionieri, 101
    50019 – Sesto Fiorentino (FI)
    Telephone: 055 50975

    Prato | Studi Medici Life

    Viale della Repubblica, 141
    59100 – Prato (PO)
    Telephone: 0574 583501

    Milan | Columbus Clinic Center

    Via Michelangelo Buonarroti, 48
    20145 – Milan (MI)
    Telephone: 02 480801

    Dr. Andrea Cocci

    urologist and andrologist

    The decision to dedicate my professional life to urology and in particular to andrological and reconstructive surgery is the result of a deep passion for anatomy , the art of surgery and in general the diagnostic-therapeutic process which leads to the recovery of the patient. Oncological pathology, infertility, erectile dysfunction, penile diseases or simply prostate disorders irreparably afflict not only the individual but also the couple dimension.

    Receive in:
    Florence, Milan, Prato

    Dr. Andrea Cocci
    Urologist e andrologist

    I am fully convinced that listening to the patient, understanding their needs, evaluating their expectations is the only way to establish a successful and satisfying therapeutic program for both the doctor and the patient.
    Linkedin Youtube Facebook Instagram