Bladder ablation is a minimally invasive medical technique used to remove or destroy abnormal tissue within the bladder. This procedure is performed by inserting specialized instruments through the urethra, avoiding the need for an external incision. The destruction of the target tissue is typically achieved using focused energy, such as heat from a laser, radiofrequency, or electrocautery. This precise application of energy treats problematic areas while minimizing damage to the surrounding bladder wall.
Conditions Treated by Bladder Ablation
The primary indication for bladder ablation is the management of early-stage or superficial bladder cancer, most commonly through Transurethral Resection of Bladder Tumor (TURBT). This involves shaving away the cancerous growth and cauterizing the base to destroy residual tumor cells. This approach is often curative for tumors that have not yet invaded the deep muscle layer of the bladder wall.
Ablation techniques are also used for non-cancerous conditions that cause significant symptoms. One such condition is interstitial cystitis (IC), a chronic pain syndrome, where ablation may destroy Hunner’s ulcers found on the bladder lining.
Controlling persistent, severe bleeding (hematuria) is another indication when conservative measures have failed. This often relates to hemorrhagic cystitis, where the bladder lining is inflamed and bleeds, commonly as a side effect of cancer treatments. The suitability of ablation depends heavily on the size, location, and depth of the abnormal tissue.
The Ablation Procedure
Bladder ablation is an endoscopic procedure performed using a cystoscope, a thin tube equipped with a light and a camera. The cystoscope is inserted through the urethra and guided into the bladder, allowing the surgeon to visualize the inner surface on a monitor. The procedure is typically performed under regional or general anesthesia, though some laser ablations can be done using a local anesthetic gel.
Once the abnormal tissue is located, specialized instruments are passed through a working channel within the cystoscope. These instruments deliver the destructive energy directly to the target area. Electrocautery uses a high-frequency electrical current to destroy the cells, while laser ablation employs a focused laser fiber to vaporize the tissue.
The surgeon applies the energy to destroy the lesion, often taking a tissue sample for laboratory analysis, especially if cancer is suspected. Sterile fluid is continuously flushed into the bladder to maintain visibility and rinse away debris. After the tissue is destroyed, the instruments are withdrawn, completing the procedure, which is often an outpatient surgery.
Preparing for the Procedure
Preparation typically begins with pre-operative testing, including blood work and imaging scans, to ensure overall health and confirm the procedure’s plan. Instructions regarding food and drink are provided, as fasting is required before receiving anesthesia. Patients are usually instructed not to eat or drink anything after midnight, though small sips of water may be allowed for necessary medications.
The surgeon must review the patient’s medication regimen, particularly concerning blood thinners. Since these medications increase the risk of bleeding, a doctor will advise whether to stop them temporarily. Logistical planning is also necessary, as the effects of anesthesia require patients to arrange for a responsible adult to drive them home after the procedure.
Recovery and Potential Complications
Following ablation, patients are monitored in recovery for a few hours before discharge, as many procedures are outpatient. It is common to experience a burning sensation during urination and to pass pink or red-tinged urine (hematuria) for up to a week. Drinking plenty of fluids is recommended to flush the bladder, dilute the urine, and prevent the formation of blood clots.
Some patients may temporarily require a urinary catheter if they have difficulty urinating post-procedure. Although rare, potential complications include a urinary tract infection (UTI), which requires antibiotic treatment. More serious risks include significant bleeding that might require intervention, or a bladder perforation (a small tear in the bladder wall). Patients should contact their care team immediately if they experience escalating pain, an inability to pass urine, or a high fever.