Transurethral Resection of Bladder Tumour (TURBT) Surgery Waiting Times Update

Find out about the latest waiting times and length of hospital stay for transurethral resection of bladder tumour (TURBT) surgery with Dr Foster Health

Transurethral Resection of Bladder Tumour (TURBT) summary

Transurethral Resection of Bladder Tumour (TURBT) is an operation to remove superficial (non-invasive) bladder cancer. The following section clarifies this condition and resulting medical procedures.

What is the bladder?

The urinary bladder is basically a hollow, muscular bag. Urine drains into the bladder from the kidneys through two tubes (ureters) and can be stored there or expelled by muscular contractions through a tube (urethra) to the outside of the body.

What is bladder cancer?

Bladder cancer occurs when a tumour grows in the lining of the bladder. A tumour develops when cells divide abnormally and bunch together to form a lump, which, if malignant (cancerous), can spread to other parts of the body.

The two main types of bladder cancer:

1. Non-invasive - the cancer is contained within cells that form the inner lining of the bladder
2. Invasive - the cancer has spread to the muscle layer of the bladder or to other organs

TURBT operation for non-invasive bladder cancer

During a TURBT operation, the surgeon uses a surgical tool called a resectoscope - a long thin tube with a tiny camera and light source at one end - to remove cancerous tumour(s) from the bladder.

The surgeon will pass the thin tube of the resectoscope down the urethra and into the bladder. The surgeon will then be able to see what is happening inside the bladder by watching a monitor where the images from the camera are displayed.

Surgical instruments inside the resectoscope access the bladder and the abnormal area is then resected (removed).

Waiting times for TURBT

Government cancer targets have gone some way to reducing waiting times for TURBT.

Dr Foster Health data shows that waiting times for TURBT have generally been falling year-on-year in all Strategic Health Authorities (SHA) since 2005/6:

Fig 3 - Average waiting times for TURBT by Strategic Health Authority (SHA)

Across all 10 Strategic Health Authorities, the average waiting time for a TURBT operation in 2008/9 is about 33 days. You will wait the shortest time for a TURBT (28 days) if you live in the South Central SHA. You will have the longest wait (37 days) if you live in the London SHA.

Hospital length of stay for TURBT

The following graph shows you the average length of stay in hospital after TURBT surgery according to age group.

Fig 4 - TURBT: Spells & length of stay by Age Group

Inpatient spell: a patient's stay in hospital consists of at least one finished consultant episode (period of care under one consultant/team)

Figure 4 shows that as patients get older they are more likely to stay in hospital for longer after a TURBT procedure.

Across all age groups, the average length of stay in 2008/9 is between two and three days in hospital.

New developments in the treatment of bladder cancer

The following medical treatments are under investigation in clinical trials and may not be available at NHS or private hospitals unless you are part of a clinical trial. These treatments may become available at a later date, if researchers can demonstrate they are clinically safe and effective.

1. Genetic changes in bladder cancer - a number of clinical studies are looking at different tests that can detect DNA abnormalities and help doctors predict the prognosis (how successful the treatment will be) of bladder cancer patients as well as choose the appropriate treatment for a particular patient ⁽¹⁾
2. Prevention of bladder cancer - even if your bladder cancer was treated successfully, you are at risk of developing a new cancer in the bladder, lining of the kidneys, ureters and urethra. Studies are looking at the properties of specific vitamins or minerals which may reduce the risk of a second cancer ⁽²⁾. Further studies are looking at a non-steroidal anti-inflammatory drug called celecoxib, while other researchers are looking for a vaccine to help lower the risk of developing a second cancer ⁽³⁾
3. Photodynamic therapy (PDT) - PDT is a potentially useful treatment for non-invasive bladder cancer that kills cancer cells in a targeted way ⁽⁴⁾. The patient is injected with a harmless chemical, which builds up in the bladder over several days. Then a special type of laser light is focused on the bladder through a cystoscope. The laser light changes the chemical that has collected in the cancer cells into a new chemical that can kill them
4. Chemotherapy - a number of chemotherapy drugs are being tested as treatment for bladder cancer. Some of these, such as irinotecan ⁽⁵⁾ and oxaliplatin ⁽⁶⁾ are already used to treat other types of cancer
5. Anti-angiogenesis drugs - anti-angiogenesis drugs slow down cancers by starving the tumour/s of blood. Bevacizumab ⁽⁷⁾ and sorafenib ⁽⁸⁾ have been effective against colorectal cancer and kidney cancer, and are currently being tested in patients with bladder cancer
6. Targeted therapies - a number of studies are investigating the molecules within bladder cancer cells which control their growth and spread to develop new targeted treatments. Some of the drugs are used to treat other cancers, such as lung and colon cancer ⁽⁹⁾. A number of clinical trials are testing the following drugs to fight bladder cancer: lapatinib ⁽¹⁰⁾; erlotinib ⁽¹¹⁾; trastuzumab ⁽¹²⁾; and gefitinib ⁽¹³⁾
7. Gene therapy - Gene therapy uses special viruses that have been modified in the laboratory. The modified viruses are injected into the bladder and inject selected genes into the cells of the bladder. For example, the GM-CSF gene helps the cells produce an immune system hormone (cytokine) that researchers hope will activate the immune system to attack the cancer ^(14/15)