What is a transurethral resection of a bladder tumour (TURBT)?
Posted on 26 October 2017
This non-invasive urology procedure might potentially save the lives of many people suffering from localised bladder tumours.
Bladder cancer is one of the top ten cancers worldwide and is more prevalent in men than women. Approximately 80% of patients present with non-invasive bladder tumours that are localised to the lining of the bladder. The remaining 20% are muscle invasive or more advanced and may require more invasive procedures, including removal of the bladder (cystectomy). (https://www.cancer.gov/types/bladder/hp/bladder-treatment-pdq)
The collaborative Public Private Initiative (PPI) that Mediclinic Southern Africa is rolling out across the Western Cape in partnership with Groote Schuur Hospital seeks to reduce the time state patients spend on waiting lists for elective surgery. As part of this significant partnership between the public and private healthcare sectors, twelve public-sector patients recently underwent transurethral resection of bladder tumour (TURBT) procedures at Mediclinic Stellenbosch.
Dr Jonathan Wicht, a specialist urologist at both Somerset Hospital and Groote Schuur Hospital who performed these procedures on a pro bono basis, explains that for patients with localised bladder tumours who are operated on in time, the TURBT might be the only treatment they need. ‘If there are long waiting times, however, some cases will progress, and those patients will require more advanced procedures – such as chemotherapy, or having the bladder removed (radical cystectomy).’
Dr Wicht adds that patients between the ages of 40 and 60 who present with blood in their urine (haematuria) may need investigation especially if they are smokers. ‘We diagnose cancer by inserting a camera through the urethra into the bladder to look at the lining of the bladder. If we see something suspicious we schedule or perform a TURBT.’
This procedure involves going into the urine system endoscopically (which is a less invasive manner) to shave or resect these tumours from the inner lining of the bladder.
The patient is given an anaesthetic (either general or spinal/regional) before the surgeon inserts a cystoscope through the urethra into the bladder. The tumour is then shaved off the bladder wall by means of a resectoscope, an instrument that uses electrical current through a small wire loop to cut the tumour and is used to stop the bladder from bleeding. Although the procedure is non-invasive, it is not without risk.
During surgery, irrigation solutions are used to distend the bladder and to improve visualisation of lesions, Dr Wicht adds. Both the surgeon and the aneasthetist are vigilant and careful to prevent, detect and correct any complications should they present.
This Public Private Initiative programme is the third of its kind where Mediclinic collaborates with the Western Cape Department of Health. The first involved 90 cataract patients in 2007, then 10 tonsillectomies in 2008. By December this year, over 100 surgical procedures (including cataract removal and eardrum repair) would have been performed at four Western Cape Mediclinic facilities. Patients who receive these treatments are identified via the Groote Schuur waiting list and suitable candidates are fast-tracked through the partnership.