Please note: This page is intended for healthcare professionals only. It is designed as a general educational guide and does not replace local guidance, senior clinical advice, or individual clinical judgement. Patients should not use this page as medical advice and should seek advice from an appropriate healthcare professional.

Bladder Operations

This is a very brief introduction into most common urological operations. The list below is not exhaustive of all urological operations, but the procedures an SHO will more commonly encounter.

Cystoscopy (Flexible or Rigid)

• Endoscopic inspection of the urethra and bladder using flexible (LA) or rigid (GA/spinal) instruments
• Indications:
  • Haematuria, LUTS, bladder cancer surveillance, recurrent UTIs, stent change/removal, and as part of other endoscopic procedures
• Image enhancing options:
  • White light – standard visualisation
  • Blue light (photodynamic diagnosis / PDD) – uses hexaminolevulinate (Hexvix) to enhance detection of CIS and small papillary tumours
  • NBI (Narrow Band Imaging) – enhances mucosal and vascular detail without dye; improves detection of flat or subtle lesions
• Risks: LUTS, transient dysuria/haematuria, retention
• Setting: Flexible – outpatient; Rigid – usually day case under GA/spinal

 

Bladder Tumour Procedures

TURBT – Transurethral Resection of Bladder Tumour

• Resection of tumour using a diathermy loop (monopolar or bipolar)
• Purpose – both for diagnosis + treatment of bladder cancer
• Post-operatively will often have intravesical Mitomycin C to reduce risk of further recurrences
• Usually home same or next day
• Risks:
  • Common – haematuria, LUTS, retention, need for further follow-up or treatments
  • Serious – perforation, injury to ureteric orifices causing obstruction, bleeding needing transfusion or return to theatre, stricture

TULA – Transurethral Laser Ablation of Bladder Tumour

• Minimally invasive laser ablation of small, low-grade bladder tumours, suitable for outpatient or ambulatory settings
• Performed via flexible or rigid cystoscopy using a laser fibre (commonly Holmium or Thulium)
• Ideal candidates:
  • Often used for frail patients, anticoagulated patients, or low-risk recurrences seen on surveillance cystoscopy
  • Your unit might have different patient referral criteria – refer to this!
• Advantages:
  • Less bleeding
  • Can be done under local anaesthetic
  • Minimal recovery time
• Limitations:
  • Not suitable for large, multifocal, or high-grade tumours (which require TURBT for proper staging and complete resection)

 

Cystectomy & Urinary Diversion

• Simple cystectomy – for benign conditions such as radiation cystitis or severe bladder dysfunction
• Radical cystectomy – bladder cancer

Radical cystectomy – sex-specific anatomy:

• Men: usually a cystoprostatectomy (bladder + prostate + seminal vesicles)
• Women: typically an anterior exenteration (bladder + urethra + uterus + anterior vaginal wall ± ovaries)
• Selected patients (large, invasive, or recurrent disease) may require total pelvic exenteration which involves removal of bladder, reproductive organs, and rectum

• Urinary diversion – options include ileal conduit, orthotopic neobladder, or continent diversion
• Risks – this is major surgery – risk of bleeding, urine leak, bowel complications, ileus, hernias, dehiscence and metabolic disturbances
• Recovery – length of stay typically 5–14 days (shorter with ERAS pathways)

• Post-op monitoring:
  • Persistent high drain output (day 3–4) → consider sending drain fluid U&Es (brown bottle) to exclude urine leak