Tumor 2.5–5 cm: tactics
Formations of this size are removed in fragments: first the exophytic part, then the base with the muscle, a biopsy of the edges and the bottom of the bed is taken separately - these fragments are marked and examined separately, which is important for staging. The bed is widely coagulated; if the ureteral orifice is involved, a stent can be installed. Due to the larger volume of tissue, the likelihood of invasion is higher, so a second-look TUR is often performed and a course of intravesical BCG or chemotherapy is prescribed. Follow-up: cystoscopy every 3 months for the first 2 years.
Indications
- tumor (papillary formation) of the bladder, detected by ultrasound or cystoscopy;
- blood in the urine with suspected neoplasm;
- non-invasive bladder cancer (Ta, T1, CIS) is the main treatment method;
- repeat (second-look) TUR after 4–6 weeks for T1 and high risk - for the exact stage;
- leukoplakia of the bladder that is not amenable to conservative treatment;
- tumor recurrence during follow-up.
How is the operation performed?
Under spinal (less commonly general) anesthesia, a resectoscope with a video camera is inserted through the urethra. The bladder is filled with a solution, the surgeon examines the entire mucous membrane and sequentially removes the formation with an electric loop: first the exophytic part, then the base with the underlying muscle layer - it is its presence in the preparation that allows the histologist to determine whether the tumor is growing into the muscle. The tumor bed is coagulated, in case of multiple formations, all are removed, and biopsies are taken from suspicious areas.
The fragments are evacuated and sent entirely for histology. For confirmed superficial cancer, a chemotherapy drug is injected into the bladder in the first hours after TUR - this reduces the risk of relapse. The catheter is installed for 1–2 days. The operation takes 30–60 minutes depending on the size of the formation (in the price list of clinics - up to 2.5 cm, 2.5–5 cm, more than 5 cm).
Preparation
Diagnosis includes cystoscopy, ultrasound, urine cytology and MSCT or MRI of the pelvis with contrast to assess the depth of invasion and lymph nodes. Tests: general and biochemical blood test, coagulogram, general analysis and urine culture (infection is treated before surgery), ECG, consultation with an anesthesiologist. Anticoagulants are discontinued 5–7 days in advance in agreement with the cardiologist. Hospitalization on the day of surgery, 8 hours on an empty stomach.
After TUR: histology and observation
The patient spends 1–3 days in the hospital. In the first 1-2 weeks, frequent urges and blood may be present - as the bed heals, they disappear. After 7–10 days, histology is ready: tumor type, degree of malignancy (low/high grade), depth (Ta, T1, T2). For a superficial tumor, treatment is supplemented with a course of intravesical chemotherapy or BCG therapy; for muscle invasion, radical cystectomy is discussed. Observation is mandatory: control cystoscopy after 3 months, then every 3-6 months in the first 2 years and annually thereafter - bladder cancer is prone to recurrence, and early cystoscopy allows them to be removed without major surgery.
Bladder TOUR in Tashkent
In clinics below, TUR is performed by urological oncologists with endoscopic experience using bipolar equipment; histology is included in the price, intravesical chemotherapy and BCG therapy, MSCT and cystoscopic control are available. Make an appointment with the results of an ultrasound or cystoscopy.
