Endoscopic Surgery for Bladder Cancer
What does Endoscopic Bladder Surgery Involve?
Endoscopic surgery is performed when it is considered the most effective and suitable treatment to treat superficial tumours after diagnosis of bladder cancer.
Endoscopic surgery, which is called transurethral bladder resection, is often used on patients with superficial tumours.
The operation allows tumour fragments to be collected. These fragments are assessed to check if the tumour is superficial (merely affecting the bladder’s surface lining) or invasive (affecting the bladder’s muscle wall).
The advice given to the patient differs completely depending on whether the tumour is one or the other.
What is the Endoscopic Surgical Procedure?
This surgery can last from 15 to 90 minutes depending on the size of the tumour and can be performed under general or spinal anaesthetic.
No incision is made, as it is performed via the urethra with a very narrow endoscopic device called a resectoscope.
The aim of endoscopic surgery is transurethral resection, a technique to remove a visible tumour that is later sent for histopathological analysis.
At the end of the surgery, “haemostasis” is performed, i.e., the careful process of coagulation when the tissue in the area housing the tumour is fulgurated ("burned") so there is no major haemorrhaging after surgery. The urologist may also use a laser to destroy cancerous cells.
Surgery is performed on cancers of the type that occur in the bladder but in the upper urinary tract. Treatment of these tumours is much more technically demanding than in the bladder, since, understandably, access to the urether and kidney is a lot more difficult and the devices used are much smaller.
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What is the Post-Treatment for Endoscopic Surgery?
Many patients who have surgery on a superficial tumour have a favourable prognosis and, although there is often a recurrence of the tumour in later years, most never develop invasive cancer.
Accordingly, it is essential for the patient to receive the recommended follow-up, particularly by cystoscopy (bladder endoscopy) after surgery. Initially these are held at shorter intervals of every 3 months, but later the necessary frequency drops (every 4 months, then every 6 months until, finally, once a year). This follow-up protocol varies depending on the tumour. Urine cytology may also be requested, as well as other imaging exams such as ultrasounds and computed tomography (CT) scans. Follow-up generally continues beyond 5 years.
To reduce the risk of a recurrence of the tumour, these patients generally undergo a treatment with medication that is placed ("instilled") inside the bladder.
The protocols vary depending on the product used and the frequency of instillations. The products most commonly used are:
- Mitomycin C (a cytostatic placed inside the bladder and not administered endovenously, hence the term “intravesical chemotherapy”);
- BCG – which triggers a local immunological reaction that destroys cancerous cells, hence the name “intravesical immunotherapy”.
These drugs are administered at variable intervals but generally weekly (at the initial stage) and then monthly, in the case of mitomycin C. For BCG, the interval is weekly for 3–6 weeks in cycles that are generally repeated every 3 months.
Furthermore, it is essential that patients refrain from smoking (if that is the case).
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Endoscopic Surgery for Bladder Cancer
What is endoscopic bladder surgery?
What is the fulguration process?
- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- Bladder Cancer Surgery - https://www.cancer.org/cancer/bladder-cancer/treating/surgery.html
- Transurethal telescopic resection - https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Bladder%20tumour%20resection.pdf
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