Trans Urethral Resection of Bladder Tumor (TURBT) Treatment in Tunisia

Statistical reports gathered in the year 2013 shows more than 10,000 individuals diagnosed with bladder cancer in the United States. Among them, successful results were obtained from the individuals who were diagnosed in the early stages and treated with TURBT. The treatment offers a reliable and successful approach. However, in some cases, the malignant tumor may only get removed after repeated TURBT treatment. This is because, a number of cases have shown recurrence of tumors post TUR. 

What is Trans Urethral Resection of Bladder Tumor (TURBT)?

Trans Urethral Resection of Bladder Tumor Treatment (TURBT) is one of the advanced procedures for treating tumors in the primary stage. Mostly in case of malignant tumors, TURBT offers a satisfactory solution and provides ample time for further treatments. Implementing TURBT in the initial stage, not only removes the tumor but also prevents the tumor from spreading to the nearby majority organs. The procedure is executed by inserting fine tube through the urethra which then travels to the target position and removes the tumor in the initial stages. 

Symptoms of Patient Undergoing TURBT Treatment

The patient undergoing a TURBT procedure may have to stay for a minimum of one to two days. However, one may require one to two weeks of bed rest, during which the individual may experience certain symotoms like: 

  • Asymptomatic hyponatremia
  • Changes in the ECG, 
  • Fatigue
  • Nausea
  • Vomiting
  • Loss of appetite
  • Confusion
  • Visual impairment 

Factors Affecting the Cost of TURBT

In general, a traditional TURBT treatment cost may vary from a minimum of $3000 to a maximum of $6000. However, the prices may vary due to some key factors, on which the procedure depends: 

  • The country where the procedure is being performed
  • The extent of number of procedures required
  • Underlying health conditions, if any
  • Type of healthcare facility availed
  • Proficiency and experience of the surgeons involved.
Treatment and Cost

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Treatment cost starts from

USD 6500

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About the Trans Urethral Resection of Bladder Tumor (TURBT)

Cancer in Bladder can be found to vary depending on the type of its origins. It can arise from the lining of the epithelium which is the inner lining of the urinary bladder or the urothelium. Rare forms of cancer are not of epithelial origins like the sarcoma or lymphoma. Tumours in bladder is found to be the 9th leading type of cancer in United States as per a survey conducted in 2012 with 430,000 new cases and mortality of 165000 deaths annually.

About Trans Urethral Resection of Bladder Tumor

The first and foremost question to ask is where is your bladder located? The sac like muscular urinary bladder is located in the pelvis region above the pelvic bone. It is connected to the kidneys through the two ureters that transfer the urine from the kidney to the bladder for storage. An abnormal growth of cells in the inner lining causes a tumour requiring diagnosis and then followed by a turbt surgery.

In most cases the tumour cannot be assessed in the primary stages. There are hardly any notable evidences found when the patient is harbouring a primary tumour.

The next stage is designated as Oa and categorized as a non invasive type papillary cancer.
In the stage next of the stage 0 or the carcinoma in situ the inner lining of the bladder is affected and is still considered non invasive.
In stage I the cancer has spread into the lining of the bladder further but has not affected the muscular wall of the bladder.
While in Stage II the inside part gets affected including the muscles of the bladder making it now invasive.
And when the cancer has spread enough in muscles and the tissues around the bladder like the reproductive organs it is considered to be in stage III.
And in the final or stage IV the cancer will spread to the lymph nodes affecting the organs around it as well.

Causes of developing a tumour in bladder

The causes of tumour in bladder are not always very clear and well defined but it has been linked with smoking, chemical exposure and radiation or a parasitic infection. The abnormal cells undergo some mutation that allows them to multiply in a non orderly fashion and goes beyond control and they do not die thus giving rise to the tumour.

Symptoms of the TURBT

A person suffering from a tumour will experience mild sensation of burning and discomfort in the times of urination for quite a few days. The force of the urinary stream may also undergo significant changes which can be observed for a week to a fortnight. Usually there could be none of the symptoms and in certain cases all symptoms even if experienced may not lead to the conclusion that it is a bladder cancer. There can be blood or clots of blood in the urine along with a tendency of urinating too frequently. Tendency of urinating at night may be felt more but there can be general problems in urine passing. Associated along with this the patient can experience pain on either side of the body.

What is transurethral resection of bladder tumour?

This procedure aims at removing bladder tumours at an early stage by inserting a scope through the urethra leading to the bladder. In the TURBT procedure bladder cancer can be detected by the urologist and potentially allow the urologist to treat various other kinds of bladder related disorders. But 75% of the cancer of bladders that are detected are superficial in nature causing growth only on the surface of the walls of the bladder and does not get very deep. So this facilitates the surgeon to have the tumour removed at the bladder wall level causing no damage to the deeper layers of the organ. The information that is collected while executing the procedure will help the surgeons to decide the type of the abnormality of the tumour and the extent of the tumour. This later allows the urologist surgeons to decide whether further treatments will be required or not.

What are the alternatives for TURBT procedure?

Some of the other treatment alternatives for TURBT are being worked upon while some of them have tremendous side effects

Blue light fluorescent cystoscopy : Enhanced tumour visualization is possible and detection of tumour chances are increased by almost 20 to 25% with this method where an ultraviolet blue light is used. A dye is injected an hour prior to the procedure.

Adjuvant bladder cancer therapy: TURBT is not suitable for many who have high chances of suffering a recurrence within 12 months from the treatment. In this case adjuvant therapy is recommended. It includes intravesicle chemotherapy. Chemotherapy for bladder cancer includes giving medication to curb the abnormal growth of cells. But it also has its sets of side effects like experiencing irritation in bladder and loss of hair, nails and feeling debilitated for a very long period of time.

How is Trans Urethral Resection of Bladder Tumor (TURBT) performed?

  • The techniques of anaesthesia used are all suitable for TURBDT procedure. In case of spinal anaesthesia the patient stays awake and the surgery team can stay alert for any TUR Syndrome. This is a rare complication but cannot be ignored still. But for complex tumours the resection does not prefer spinal anesthesia as obturator reflex where a leg thrust which is very powerful can be felt. So if tumour location is not known general anaesthesia is preferable with endotracheal tube or LMA allowing surgeon the flexibility for long as well as short term paralysis.
  • For achieving proper positioning Mitchell slings and split leg spreader table attachments are employed. In the dorsal lithotomy position when a patient is positioned then care is taken to ensure that all the points of pressure are adequately padded and none of the joints are flexed beyond 90 degrees. Peroneal nerve injury has to be avoided as there are chances of the same during compression of the nerve on the lateral fibular head.
  • With betadine scrub, chlorhexidene or with any other antiseptic agent the area is cleaned, and then covered with sterile drapes. The wires and cords are positioned as per the convenience of the surgeon. On the abdomen of the patient a video monitor is positioned at a suitable height ensuring comfort during the procedure and prevents neck or head strain as much as possible.
  • The Iglesias type continuous flow resectoscope is preferred and it allows the surgeon to control both inflow and outflow which when controlled for proper equilibrium will ensure constant volume in the bladder and having the tumour fixed in position and also have the vision cleared when coming across bloody fields.
  • The bladder has to be prevented from being overfilled and has to be maintained at half the volume all throughout the resection procedure. For small and moderate tumours the attacked area should be directed towards the tumour’s stalk.  The stalk of the tumour is at times hidden by the fronds or papilla of the tumour. Due to this there can be brisk bleeding which is continuous until and unless the large blood vessels. If the stalk does not get identified easily some of the fronds must be trimmed and then the stalk can be addressed.
  • Next the normal bladder mucosa and stalk has to be resected around the stalk circumferentially. During the resection of larger tumours it is suitable to send the chips resected separately for the pathologist so that they can identify the muscle fibers to signify sufficient resection.  Stalk base biopsies which are deep in the muscosa are also good for identifying muscle specimen.
  • Hemostasis has to be achieved after complete resection of the tumour, the resection site bases are painted and the mucosa edge around the tumour can ensure hemostasis adequately.
  • By a highly vascular stalk the papillary tumour is attached to the bladder. In order to get near the stalk surgeon must chip at the tumour’s periphery. The surgery is all about finding the stalk fast and addressing it to control it. That can at least stop the bleeding. But at times due to the size of the tumour it becomes difficult to locate the stalk and the surgeon has to look for the stalk evidence patiently.
  • With the help of an Ellik evacuator the bladder has to be irrigated copiously and the chips must be evacuated. The site has to be monitored to detect any bleeding, and the chips have to be removed before they clog the catheter. The irrigation has to be stopped and any remaining chips should be allowed to settle at the bottom of the bladder. With the help of a loop it must be grasped and manually pulled out from the bladder and Ellik can be used till all the chips are removed.
  • A large bore catheter should be placed. While some surgeons use 3 -way irrigation, this must be avoided to prevent catheter clotting off causing bladder perforation. Manual irrigation can be ideally used to maintain free flow of fluid. Lasix dose is used to create physiologic 3-way irrigation and it can simultaneously treat hyponatremia after the resection.

Recovery from Trans Urethral Resection of Bladder Tumor (TURBT)

A catheter will be given to the patient while going home and nurses will instruct how to maintain it clean and use it as a drainage bag. How to remove the catheter will also be taught which is a very simple and easy step and has very little discomfort associated with it. Antibiotic can be used in the form of ointment around the tip of the catheter to reduce irritation. Usage of an overnight bag is very convenient since it can store the urine for a longer period of time. It happens that there may be some blood clots that may pass while urinating; this must not scare you as it is normal. Addition to the overnight bag while walking a leg bag can also be worn. But if you find persistent clotting and large clots or the catheter is found not draining urine any more you should inform your surgeon.

The total period of recovery is pretty long as 6 weeks and can be divided into two weeks and then the last 4 weeks. During the first 2 weeks the patient is expected to behave as leisurely as possible and do very light activities and sexual activity must be avoided during this period. Of course within the first week one should go and collect the biopsy report and adhere to the medications prescribed by the doctor. In the next 4 weeks the patient can slowly resume back normal activities with periodic checkups with the doctor to understand the health and chances of recurrence.

Pros and Cons

Pros

  • It is the first line treatment which can detect stage and do treatment of visible tumours.
  • It can control low risk lesions without cost incurrence and inefficiencies of the operating room

Cons

  • It is not effective for carcinoma in situ
  • Runs the chances of recurrence
  • Recovery period is long

Patient Stories

Frequently Asked Questions

What is the health care infrastructure of Tunisia / Why should opt for Tunisia as a destination for your medical treatment?
Hospitals in Tunisia are developing and trying to meet the international standards of healthcare. Although there is a basic set up in most of the hospitals for treatment in Tunisia, one can still expect scope for improvement. The Ministry of Health, along with the Government of Tunisia is making effective changes for the healthcare sector. The private hospitals in Tunisia are also undergoing a robust change to provide effective healthcare and treatment in Tunisia.

Like most other countries, hospitals in Tunisia have a private and public healthcare system. Hospitals in Tunisia include three levels of care: primary, with a network of 81 clinics and 2091 basic health centers; secondary, with 109 district hospitals; and tertiary, with 33 regional hospitals and 24 modern CHUs, according to MoS figures.
What are the conditions of the hospitals in Tunisia? Are they JCI certified? What is the quality of the support staff in the hospitals?
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety.
In Tunisia, there are no JCI accredited hospitals but 4 private hospitals are certified ISO and OHSAS (Occupational Health and Safety Assessment Series).
Are the doctors/surgeons in Tunisia of the best quality?
The hospitals in Tunisia have seen a constant change in terms of development and technology. Most doctors that are trained in the country understand the needs and requirements of people and are able to diagnose and treat them well. There are various surgeons that fly in from other countries as well to treat patients. This was brought about due to the economic reforms and various expats residing there. The varying levels of health organizations provide reasonable means of treatment for any patient. There are also trained paramedical and emergency service staff in this country.
What is the process for obtaining a medical visa in Tunisia?
Patients who wish to visit Tunisia for medical purposes must contact the Embassy of Tunisia in their home country. One is required to have a valid passport. Those applicants must submit their visa application forms in person together with the following documents:
  1. A duly completed application form with one picture (within a white background).
  2. Original biometric passport and one copy. Passports should have a validity of at least one year from the date of your visa application submission.
  3. Medical certificate stating the type of illness and the treatment to be carried out. This document has to be in English or Spanish language.
  4. Letter from the hospital in Tunisia stating the appointment date and whether the treatment expenses have been already paid in full.
  5. Proof of financial means which enable the applicant to meet life needs while in Tunisia (salary certificate if working, bank statement for the last six months, property deeds, commercial license, other sorts of income).
  6. Travel insurance.
  7. Proof of accommodation (hotel reservation, etc)
  8. Applicants are advised that ALL PASSPORTS HAVE TO REMAIN at the Embassy premises while the visa application is under process (between 10 and 15 days), and therefore cannot be retrieved unless very special and urgent circumstances might arise.
  9. The Embassy has the right to require from the applicant any document that it may deem relevant in order to resolve the visa file.
What support services does MediGence provide in Tunisia?
MediGence enables you to plan and manage your medical decisions better. These are some of our services offered:
  • Expert Opinion
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  • Doctor Validation and Communication
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  • Options to Choose From
    Based on your choice of destination and other preferences, we provide you multiple options with respect to hospitals and doctors to choose from.
  • 24X7 Patient Care Support
    A dedicated patient case manager stays in constant touch with you to help you at every step of the decision-making process and resolve queries that you may have.
  • Transparent Treatment Cost and Other Expenses
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  • Visa Assistance
    We provide and help prepare documentation for visa approval and coordinate with the embassy to expedite the visa process.
  • Accommodation Arrangements
    We propose to you a choice of accommodation based on your preference such as long stay, short stay, or luxury properties.
Which are the best cities in Tunisia for medical treatment?
Tunis is the largest country and capital of Tunisia. This country is located in the northern region of Africa and is the best city for treatment in Tunisia.

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