Urology - Trans Urethral Laser Ablation (TULA) Treatment

This leaflet is for patients who have been recommended a TULA procedure for a suspected bladder tumour.

What is TULA?

TULA or trans urethral laser ablation is a flexible cystoscopy (an examination of the bladder using a camera on a thin flexible tube) that uses laser treatment to remove any reoccurring tumours or suspicious areas. A biopsy may also be taken of the abnormal area.

Using the laser will enable you to have the procedure under local anaesthesia, you should be able to go home the same day following the procedure. This will be undertaken either in an Out-patient area or in a Theatre. TULA usually takes between 15 and 30 minutes to complete.

Are there any alternatives?

A rigid cystoscopy can be undertaken but this will require a general anaesthetic.

How do I prepare for it?

• There is no special preparation required, you can eat and drink as normal
• You will be asked to provide a urine sample on admission to ensure that you are infection free. If there is any evidence of infection, the procedure may be cancelled due to the risk of sepsis
• If you take blood thinners (anticoagulant medication) such as Aspirin, Clopidogrel, Warfarin, Rivaroxaban, Apixaban, Dabigatran (or any other blood thinning medication) regularly, you can continue to take these for this procedure

Details of the procedure

• You will be awake throughout the procedure
• You will be asked to wear laser protection glasses throughout the procedure
• To minimise discomfort, a local anaesthetic gel will be inserted into your water pipe (urethra)
• A fine telescopic flexible tube will be passed through your urethra to examine your bladder (cystoscopy)
• You may require a biopsy of the abnormal area in your bladder. This will be taken through the flexible telescope
• The laser fibre is passed through the flexible telescope and the tumour is destroyed. There is usually minimal discomfort with this procedure
• You will be able to go home straight after your procedure
• If required, you may be discharged with some antibiotics
• Following your procedure, a letter will be sent to your GP

What are the risks or possible complications of TULA?

Common (greater than 1 in 10 patients)

• Mild burning or bleeding on passing urine: If present, this should improve within a few days. If it continues, please consult your GP, as you may have a urine infection.

Occasional (between 1 in 10 and 1 in 50 patients)

• Urine infection - if you have persistent burning sensation when passing urine, or feel feverish, please consult your GP as an infection maybe present, which will require antibiotics
• Temporary insertion of a catheter - if the procedure is prolonged and or bleeding occurs, a temporary catheter (tube) may be placed into your bladder at the end of the procedure. This is usually removed the following day

Rare (less than 1 in 50 patients)

• Persistent bleeding - if bleeding after the procedure does not settle, you may need to be admitted to hospital so that any clots can be removed from your bladder (and any bleeding areas cauterised)
• Perforation of bladder - if a bladder tumour is lasered, a perforation of the bladder wall may occur. Usually this only means that the catheter may be kept in place a few days longer to allow the area to heal. However, if the bladder perforation causes a leakage of bladder irrigation into the abdomen, then an open operation may be required to repair the defect
• Injury to the urethra leading to scar formation - this can be treated endoscopically (through your water pipe) by dilatation (stretching) or making an incision in the scar area under general anaesthetic
• Urine retention - during the procedure, your bladder is gently filled with water so that all areas of your bladder can be inspected. Distending the bladder can cause a small risk of urine retention (unable to pass urine). For that reason, you should pass urine before leaving the department to ensure that you can. Following discharge, if you have problems passing urine contact your GP or attend your nearest A&E department

Advice following TULA

• You may have some discomfort and notice blood when passing urine, but this should settle within a couple of days and is quite normal after this procedure
• Drink plenty of fluid - aim for at least two litres daily for two or three days following your procedure. This will dilute your urine and reduce any discomfort when you pass urine. It also helps to keep the bladder flushed, so that blood clots are less likely to develop, and the urine continues to flow easily
• Take paracetamol, following the dosage advice on the packet if you have any discomfort
• Try to stay active; this will help speed up your recovery
• If you get any pain or burning when you pass urine, or you feel unwell, you may have a urine infection. Contact your GP as soon as possible.
• Important: If you become shivery, have a fever and feel generally unwell, please go straight to the nearest Emergency Department (A&E) as you may need to be admitted for extra antibiotics given via a vein
• You can resume sexual activity when you feel comfortable

Results and Follow-up appointment

• If a biopsy has been taken, this will be discussed at a multi- disciplinary team (MDT) meeting once the results are available. This can be 2-4 weeks following your procedure. After this meeting, you will be informed of the next steps in your management
• If a biopsy wasn’t required, it will be discussed with you on the day of your procedure whether you are to be seen in out-patients to return for a repeat TULA procedure or the flexible cystoscopy surveillance clinic