Bladder TURBT: instructions before and after the procedure

General and important instructions before surgery

Before surgery:

- When you are admitted to the hospital, bring all the tests done for the surgery.
- Fasting before surgery must be at least 8 hours, including water.
- There is no need to shave the hair on the abdomen and pubic area at home.
- Allergies to medications, latex, foods and others must be reported to the medical and nursing team at admission.
- Antihypertensive medications (blood pressure pills) should be taken even on the day of surgery, with the minimum amount of water needed to swallow them.

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- Some medications must be stopped before surgery:
- Oral hypoglycemic agents (diabetes pills) should be stopped the day before surgery.
- Antiplatelet agents such as acetylsalicylic acid (aspirin: AAS®, Somalgin®, etc.) and clopidogrel (Plavix®, etc.) should be stopped at least 7 days before surgery if the patient takes only one of these medications. If both are used, they should be stopped 10 days before the surgical procedure.
- Patients taking anticoagulants such as warfarin (Marevan®) or rivaroxaban (Xarelto®) should stop the medication 5 and 3 days beforehand, respectively. During this period, some patients will need to use enoxaparin sodium or unfractionated heparin until the day before surgery.

After surgery:

- After returning from surgery to the room, once the patient is fully awake, he or she may eat the diet prescribed by the medical team, according to tolerance. At this point, it is possible to get out of bed for short walks in the room, always with the help of a family member or a member of the nursing team.
- In patients in whom a bladder lesion is found requiring biopsy and/or resection (scraping), a 3-way urinary catheter will be placed in the bladder. Saline is continuously infused through one of the channels to prevent clot formation and possible blockage of the bladder catheter. During the hospital stay, care of these devices will be provided by the medical and nursing team.
- The hospital stay generally ranges from 1 to 3 days.
- The bladder catheter is usually removed at discharge. In specific situations, which your doctor will explain, it may be necessary to keep the catheter after discharge.

After hospital discharge:

- After the bladder catheter is removed, symptoms such as dysuria (burning or pain when urinating) and urgency (a strong urge to urinate) are common in the first days and tend to decrease progressively.
- Small amounts of blood in the urine are common in the first days. However, watch for heavier bleeding and/or passing clots. In that case, go to the emergency department of the hospital where you had surgery.

Diet:

- There are no specific dietary restrictions; the patient should eat a healthy diet.
- Fluids (water, tea and natural juices) can be consumed freely.

Care of the bladder catheter and urine drainage bag:

- Occasionally, the patient may be discharged with the bladder catheter in place. This catheter does not require any special care and should preferably remain secured to the thigh or abdomen. Soap and water can be used freely in the area when showering.
- Under no circumstances should the drainage bag be disconnected from the bladder catheter.
- The drainage bag must always remain below the level of the bladder, that is, below the waist, to help urine drain. When the patient is sitting, the bag can be placed on the floor.

- The urine drainage bag should be emptied 4 to 5 times a day or whenever it is full.

- Until the catheter is removed, small amounts of blood may be passed in the urine (drainage bag) or around the catheter through the urethra, usually with movement or minor exertion. Occasionally, a large amount of urine may also leak around the catheter. This usually has no significance and generally occurs when the catheter is kinked and urine cannot drain. When this happens, check the position of the catheter to make sure it is not kinked and the clamp is not closed.

- Urine drains continuously from the catheter into the drainage bag. If you notice a progressive feeling of a full bladder and an urge to urinate, and see that urine is not draining through the catheter, check that it is not kinked and the clamp is not closed. If the catheter still does not drain, it may be blocked, for example by a clot, and you should contact the medical team and go directly to the emergency department of the hospital where you had surgery.

Physical activity:

- During the first 2 weeks after surgery, the patient should maintain relative rest, avoiding strenuous work activities, lifting heavy objects and any kind of intense physical exercise. However, during this period it is important to move around carefully, and gentle daily walks are allowed.
- After 2 weeks, the patient may do light activities such as somewhat longer walks. Work that does not require physical effort can be resumed if the patient wishes. Until the sixth week after surgery, more strenuous activities should be avoided, such as running, sit-ups, tennis, soccer, horseback riding, cycling or workouts involving greater muscular effort.

- The patient is generally cleared to drive after the third post-operative week.
- After discharge, the patient may go up and down stairs carefully.
- Sexual activity can be resumed about 30 days after surgery, bearing in mind that the first experiences may be accompanied by some discomfort in the genital area.

Medications:

- At discharge, you will receive instructions about the medications to take at home. Generally, painkillers for mild pain and other symptom-relief medications are prescribed. Antibiotics are used only prophylactically before surgery and are not prescribed for home use, except in selected cases where the medical team deems it necessary.

Important:

In case of severe pain that does not improve with the prescribed painkillers, significant bleeding in the urine, fever, shortness of breath with pain when breathing, feeling unwell with a drop in blood pressure, or any other complication or question, go directly to the emergency department of the hospital where you had surgery.
- Note: This information is intended as general guidance for the patient. It does not replace the personal guidance given by your attending physician, which must be individualized according to the characteristics of the patient, the disease and the planned operation.