Trans urethral endoscopic resection (with possible Hexvix®)
When is this procedure indicated?
The procedure should be performed in all patients who following abdominal CT and/or flexible urethrocystoscopy are diagnosed with a neoformation within the bladder. It has a fundamental diagnostic value, as it allows to obtain the histological examination of the above mentioned lesion, fundamental in discriminating if a lesion is superficial or if it infiltrates the bladder musculature. In the case of a non-infiltrating lesion, it will also have a therapeutic purpose as it allows for complete removal of superficial lesions.
How is it performed?
The procedure is performed under spinal anesthesia in the operating room. No surgical cuts required. A rigid cystoscope is introduced inside the urethra, equipped with an optical fiber that transmits the endoscopic image on a high-definition monitor and an electrical resector through which the tissue suspected for neoplasia is taken. If multiple suspicious areas are present in the bladder, all of these should be resected endoscopically.
Some patients may have a suspicion of bladder neoplasia, but the absence of recognizable bladder lesions. In these cases, preoperative intravesical instillation of a fluorescence-inducing drug, Hexvix, which accumulates in the neoplastic tissue, is necessary. Subsequently, a blue light optical fiber is inserted into the cystoscope, which fluoresces the areas in which the drug has accumulated, thus making it possible to highlight areas of the bladder suspected of neoplasia, not also visible to the naked eye.
At the end of the surgery, a bladder catheter will be placed, which will be maintained for a time varying from one day to one week depending on the characteristics of the resected lesion and the health status of the patient. The hospital stay is short, on average after 2-3 days the patient can be discharged. Recovery is rapid, only abstention from intense physical exertion for about twenty days is recommended.
Complications are infrequent, and generally of low grade. In some cases, you may experience febrile episodes that require antibiotic therapy. In even rarer cases, bleeding of the resected area may occur with the presence of blood in the urine and formation of clots that may require repositioning of the bladder catheter.