Name of the Procedure:

Anesthesia for Transurethral Procedures (including Urethrocystoscopy); Transurethral Resection of Bladder Tumor(s) (TURBT)

Summary

Anesthesia for transurethral procedures involves providing pain relief and sedation during examinations and surgical interventions conducted via the urethra, such as inspecting the bladder (urethrocystoscopy) and removing bladder tumors (transurethral resection of bladder tumors—TURBT).

Purpose

This procedure is necessary to ensure patient comfort and minimize discomfort during transurethral surgeries. It allows surgeons to remove bladder tumors while the patient is pain-free.

Indications

• Presence of bladder tumors or suspicious lesions
• Symptoms suggesting the presence of bladder cancer (e.g., blood in urine, frequent urination, pain during urination)
• Diagnostic evaluations requiring inspection of the urethra and bladder

Preparation

• Patients may need to fast for several hours prior to the procedure
• Adjustments to medications, particularly blood thinners, as instructed by the healthcare provider
• Pre-procedure assessments, including blood tests and imaging studies

Procedure Description

1. Pre-Procedure: The anesthesiologist discusses anesthesia options (general or spinal/epidural) with the patient.
2. Anesthesia Administration: Depending on the chosen method, anesthesia is administered, ensuring the patient is adequately sedated or numbed.
3. Transurethral Access: The urologist inserts a cystoscope through the urethra to inspect the bladder.
4. Tumor Resection: Using specialized instruments, the urologist resects (cuts away) the bladder tumor(s), ensuring all visible tumors are removed.
5. Completion: Post-procedure, the equipment is removed, and the patient is monitored during recovery.

Tools and equipment commonly include:

• Cystoscope (flexible tube with a camera)
• Resection loops or laser fibers for tumor removal

Duration

The procedure typically takes between 30 minutes to 2 hours, depending on the complexity and number of tumors.

Setting

The procedure is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Anesthesiologist or nurse anesthetist
• Urologist (surgeon)
• Surgical nurses and operating room technicians

Risks and Complications

• Common: Bleeding, infection, urinary tract discomfort
• Rare: Anesthesia complications, bladder perforation, blood clots

Benefits

• Effective removal of bladder tumors
• Alleviates symptoms and can contribute to the diagnosis and staging of bladder cancer

Recovery

• Immediate: Monitoring in a recovery room, pain management as needed
• Short-term: Possible use of a urinary catheter for a short period, prescriptions for antibiotics and analgesics
• Long-term: Follow-up visits for monitoring and possible additional treatments

Alternatives

• Intravesical therapy (bladder instillation treatments)
• Partial or radical cystectomy (surgical removal of part or all of the bladder)
• Chemotherapy or radiation therapy

Patient Experience

Patients may feel some discomfort upon waking from anesthesia but usually receive pain management. Urinary urgency or a burning sensation might occur for a few days, which typically resolves with post-procedure care.