Transurethral resection is one of the surgical procedures in urology. It is used to remove diseased tissue from the urinary bladder.
What is transurethral resection?
Transurethral resection is one of the surgical procedures in urology. It is used to remove diseased tissue from the urinary bladder. Transurethral resection (TUR) is a minimally invasive urological surgical procedure. It is performed with the help of a resectoscope. In medicine, a distinction is made between a transurethral resection of the urinary bladder (TUR-B or TURB) and a transurethral resection of the prostate (TUR-P or TURP). While TUR-P is used to remove obstructions blocking the flow of urine from the male prostate gland, TUR-B is used to treat superficial bladder carcinomas. In 1879, German urologist Maximilian Nitze (1848-1906) set the stage for transurethral resection of the urinary bladder by inventing the cystoscope, which could be electrically illuminated. In later years, Nitze also developed cystoscopes that were suitable for surgical procedures. He also invented cauterization for the removal of bladder tumors. Max Stern (1873-1946), on the other hand, developed the prototype of the resectoscope, which is still in use today. For this purpose, in 1926, he combined Young’s punching instrument with an electric loop and cystoscope and called it a resectoscope. Since Joseph McCarthy (1874-1965) made some improvements in 1931, the medical instrument was named the Stern-McCarthy resectoscope.
Function, effect, and objectives
Transurethral resection of the urinary bladder is one of the most important methods of examination and treatment for bladder cancer. Thus, with the help of the minimally invasive procedure, superficial bladder carcinoma can not only be detected, but also treated accordingly. In the event of a positive finding, the examination can be immediately followed by treatment. Transurethral resection is the oldest method of minimally invasive surgery. A modern resectoscope is used, which consists of an outer shaft, each of which has a channel for both the supply and the suction of fluid. The inner shaft of the resectoscope contains the optical system and a transport system that is used to move the resection loop longitudinally. A video camera and a light source can be connected to the optical system. In transurethral resection, a wire loop is used, through which the flow of electric current takes place. In this way, the diseased urinary bladder tissue can be removed layer by layer. If bleeding occurs in the process, cauterization ensures its electrical obliteration. The physical basis is similar to high-frequency surgery. The resectoscope introduces and aspirates irrigation fluid at regular intervals during the operation. This ensures both good visibility and consistent filling of the bladder. The solution is free of electrolytes. This is important for low conductivity. The rinsing solution is usually composed of glycine or a sorbitol–mannitol mixture. After flushing out the resected tissue and stopping the blood, an irrigation catheter is inserted. Transurethral resection of the bladder can be performed under both general and local anesthesia. In most cases, the procedure is performed in the hospital and involves several days of stay. Before the procedure, several examinations are necessary. For example, it is necessary to clarify the patient’s condition and whether partial or general anesthesia is more appropriate. The duration of the transurethral resection is 20 to 60 minutes. It depends on the extent and spread of the bladder tumor. At the beginning of the procedure, the physician inserts the rigid resectoscope up to the patient’s urinary bladder. Then suspicious tissue is removed, the examination of which takes place in a laboratory. This procedure also makes it possible to determine what stage the tumor is in. If the transurethral resection is sufficient for treatment, the tumor tissue is removed with an electric snare. Since tumor cells that are floating around freely can develop during the resection, chemotherapy must be administered following the transurethral resection.Otherwise, these cells may re-establish themselves in the urinary bladder tissue and cause a new tumor. Treatment must be given within 24 hours, otherwise it is of no further use. In some cases, the tumor can already be completely removed by the biopsy. This then eliminates the need for further surgical intervention.
Risks, side effects, and hazards
Transurethral resection of the urinary bladder is associated with certain risks. These include, for example, injury to the urethra during insertion of the resectoscope. As a possible consequence, there is a risk of narrowing of the urethra. In the worst case, this can cause urine to back up towards the kidneys. In addition, bacteria may infect the urinary tract as a result of the procedure and cause an infection. This must then be treated with antibiotics. Another possible complication is TUR syndrome. This is a deficiency of sodium as well as a volume load due to the washing in of hypotonic irrigation fluids. As a result, there is stress on the cardiovascular system, which can even lead to right heart failure. TUR syndrome is noticeable by restlessness, confusion, nausea and vomiting. There is a risk of incontinence due to injury to the external sphincter. Thus, urge incontinence is not uncommon. It is caused by postoperative edema, bladder irritation or infection. Other conceivable risks of transurethral resection include retrograde ejaculation, bladder neck sclerosis, and inflammation of the testicles or epididymis. Some male patients also suffer from erectile dysfunction.
