TRANSURETHRAL RESECTION OF BLADDER TUMOR (TURBT)

 

Transurethral Resection of Bladder Tumor (TURBT) is a common surgical procedure used in the diagnosis and treatment of bladder cancer. This procedure involves the removal of bladder tumors through the urethra, avoiding the need for an external incision.

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Here are key aspects of TURBT:

1. Purpose: TURBT is primarily used to diagnose bladder cancer and determine its stage and grade. It can also serve as a treatment for early-stage bladder cancer.

2. Procedure: The surgeon inserts a cystoscope (a thin tube with a camera and light) through the urethra into the bladder. Special instruments are then used to remove the tumor or tumors from the bladder wall. This is usually done under general or spinal anesthesia.

3. Diagnostic Role: Tissue samples obtained during TURBT are sent to a laboratory for analysis. This helps in determining the type of bladder cancer, its aggressiveness, and how far it has penetrated the bladder wall.

                                                                                                 

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                             Anesthetic Implications for Transurethral Resection of Bladder Tumor (TURBT)

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Anesthesia type: General, neuraxial

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Airway: ETT or LMA

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Preoperative:

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• Patients are usually elderly often with multiple comorbidities

• Neuraxial anesthesia needs to be at the T10 level (blocks the pain from bladder distention by the irrigating fluid)

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Intraoperative:

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• Position: lithotomy

• Duration: 1-2 hours

• Movement can cause injury or perforation

• Absorption of a large volume of fluid can result in signs of “water intoxication”

• TURP Syndrome:  “water intoxication” with hypervolemia and dilutional hyponatremia

• TURP Syndrome:  seizures, arrhythmias, bradycardia (vagal response), and unexplained hypotension or hypertension

• The time of transurethral resection should not exceed 2 h because excessive absorption of the irrigating fluid

• The obturator nerve is a mixed nerve with motor and sensory fibers. It arises from the anterior primary rami of L2, L3 and L4 in the lumbar plexus

• Reducing the diathermy current used during resection reduces the risk of obturator jerk

• Anesthetists should factor in the obturator jerk when considering the most appropriate anesthetic technique and should consider the use of neuromuscular blockade to reduce the risk of bladder perforation

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Postoperative:

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• Pain management

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Complications:

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• Bleeding

• ​Bladder perforation

• TURP Syndrome:  volume overload, cerebral edema, hemolysis, hemoglobinuria, and hyponatremia

• Urinary Incontinence (injury to external sphincter)

• Erectile Dysfunction

• Retrograde Ejaculation

• Urethral Stricture

• Postoperative septicemia

• Aspiration

• Hypothermia

• Myocardial ischemia

• DVT

• Postoperative cognitive impairment

• Acute renal failure

• Pulmonary edema

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Sources:

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Panagoda PI, Vasdev N, Gowrie-Mohan S. Avoiding the Obturator Jerk during TURBT. Curr Urol. 2018 Oct;12(1):1-5. doi: 10.1159/000447223. Epub 2018 Jun 30. PMID: 30374273; PMCID: PMC6198773.

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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