Transurethrale Resektion der Harnblase (TUR-B)
Almost 90 percent of all bladder cancers are mucosal tumors that grow very superficially and do not penetrate deeply into the bladder wall (non-muscle-invasive bladder cancer). With transurethral resection (TUR-B), the urologist can completely "peel away" the cancerous tissue in most cases.
Depending on the size of the tumor, the procedure can take as little as 15 minutes and is performed under partial or general anesthesia. To do this, the urologist uses a camera to enter the bladder from the front through the urethra, similar to a cystoscopy. At the same time, an electrical snare is inserted through which a high-frequency current can be passed. With this snare, the surgeon places it behind the tumor and peels it away. Blood vessels are directly obliterated in the process.
Experience of the surgeon is crucial
It is important to excise the tumor deep enough, both to remove all malignant cells and to provide the pathogen with cell material from all wall layers for histological examination. Only in this way can the diagnosis of a non-muscle-invasive tumor be confirmed with certainty. The success of the operation always depends on the quality and experience of the surgeon.
NBI instead of fluorescence staining
In some cases, mucosal tumors are difficult to see with the naked eye, so there are tools available for the urologist to make them visible. In Germany, the so-called fluorescence staining (Hexvix) is widely used, which "stains" the tumors. In this case, the dye Hexvix is injected into the patient's bladder via a catheter at least one hour before surgery.
The simpler and more modern variant is Narrow Band Imaging, or NBI for short - a technique that is mainly used in the USA. Here, the light spectrum of the camera can be changed at the touch of a button by the surgeon, making difficult-to-see tumors visible without much effort. For this reason, we at the Klinik am Ring have decided to use NBI to spare patients the inconvenience of Hexvix instillation.
The procedure is usually followed by an inpatient stay of 2 to 3 nights. A bladder catheter is placed for this time to allow for recovery and healing of the bladder wall. When urination is possible again without problems after removal of the catheter, the patient can leave the clinic.
Post-resection: When is a second TUR necessary?
If several tumors, more extensive tumor areas or minimally deeper ingrown tumors are found during the operation, then according to urological guidelines a so-called post-resection is advised. This means that the operation is repeated after 6 to 8 weeks. Also in case of recurrence, TUR-B can be repeated at any time and as often as necessary and newly grown tumors can be removed.