TURBT

A transurethral resection of bladder tumor (TURBT) is a common surgical procedure used to diagnose and treat bladder cancer. During TURBT, a surgeon inserts a thin, lighted tube with a camera and tools (resectoscope) through the urethra into the bladder. This allows them to remove abnormal growths or tumors and collect tissue samples for examination.

What is TURBT?

A transurethral resection of bladder tumor (TURBT) is a surgical procedure performed to diagnose and treat bladder cancer. It involves inserting a special instrument called a resectoscope through the urethra into the bladder. This allows the surgeon to visualize, remove, and collect tissue samples from any abnormal growths or tumors without making an external incision.

TURBT is a common procedure for people with suspected or diagnosed bladder cancer. The surgeon uses a resectoscope, which is a thin, lighted tube equipped with a camera and surgical tools. This instrument is carefully guided through the urethra, the tube that carries urine out of the body, and into the bladder. Once inside the bladder, the resectoscope allows the surgeon to see the inner lining of the bladder. They can then identify any tumors or suspicious areas. Using the tools on the resectoscope, the surgeon can cut away the tumor and cauterize (seal with heat) the area to control bleeding. The removed tissue is then sent to a laboratory. Pathologists, who are doctors specializing in diagnosing diseases by examining tissues, will analyze the samples. This analysis helps determine if the growth is cancerous, what type of cancer it is, and how deeply it has grown into the bladder wall. This information is crucial for planning further treatment.

Why it's done

TURBT is primarily performed to diagnose bladder cancer and determine its stage. It allows doctors to remove visible tumors from the bladder lining, especially early-stage cancers. The procedure also provides tissue samples for laboratory analysis, which helps guide future treatment decisions and assess the need for additional therapies.

The main reason for performing a TURBT is to find out if a tumor in the bladder is cancerous and, if so, what type and how advanced it is. This is called diagnosis and staging. By removing the tumor and sending it for analysis, doctors can understand the characteristics of the cancer. For many people with early-stage bladder cancer, TURBT can also be the primary treatment. If the cancer has not grown deeply into the bladder muscle, removing the tumor during TURBT might be enough to treat it. However, follow-up treatments are often needed to prevent the cancer from returning. TURBT also helps doctors decide if more extensive surgery or other treatments, such as chemotherapy or radiation therapy, are necessary. The information gathered from the tissue samples guides these important decisions. It ensures that you receive the most appropriate and effective care for your specific condition.

How to prepare

Preparing for a TURBT involves discussing your medical history and medications with your doctor, especially blood thinners, which may need to be stopped temporarily. You will typically need to fast for several hours before the procedure. It is also important to arrange for someone to drive you home afterward, as you will be recovering from anesthesia.

Before your TURBT, your healthcare team will provide specific instructions. You will need to share your complete medical history, including any allergies and all medications you are currently taking. This includes prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. It is particularly important to tell your doctor if you take blood-thinning medications, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix). Your doctor will advise you on when to stop taking these medicines before the procedure to reduce the risk of bleeding. Do not stop any medication without your doctor's guidance. You will typically be asked not to eat or drink anything for several hours before the surgery, usually starting at midnight the night before. This is to prevent complications related to anesthesia. On the day of the procedure, wear loose, comfortable clothing. Since you will receive anesthesia, you must arrange for a responsible adult to drive you home and stay with you for the first 24 hours.

What happens during

During a TURBT, you will receive either general anesthesia, making you fully asleep, or regional anesthesia, numbing the lower half of your body. The surgeon then inserts a resectoscope through your urethra into the bladder. They use this instrument to remove the tumor and cauterize the area. Afterward, a catheter might be placed to drain urine.

Once you are in the operating room, an anesthesiologist will administer anesthesia. This is usually general anesthesia, which means you will be unconscious and feel no pain. Sometimes, regional anesthesia, such as a spinal or epidural, is used to numb your body from the waist down while you remain awake but relaxed. Your medical team will monitor your vital signs throughout the procedure. The surgeon then carefully inserts the resectoscope through your urethra and into your bladder. Sterile fluid is continuously flushed into the bladder through the resectoscope to expand it and provide a clear view. The surgeon uses the camera on the resectoscope to locate the tumor or suspicious areas. Using specialized tools on the resectoscope, the surgeon precisely cuts away the tumor tissue. They also use an electric current to cauterize the base of the tumor, which helps stop bleeding. All removed tissue is collected and sent to a laboratory for detailed examination. After the tumor is removed, the bladder is thoroughly irrigated to wash out any remaining tissue fragments or blood clots. In some cases, a thin, flexible tube called a catheter may be inserted into your bladder to drain urine and continuously flush the bladder for a short period.

Recovery & timeline

After a TURBT, you will typically stay in the hospital for a short period, often overnight. It is common to experience blood in your urine and some bladder discomfort or spasms. You will need to rest, drink plenty of fluids, and avoid strenuous activities for several weeks. Your doctor will provide specific instructions for your recovery and follow-up care.

Immediately after the procedure, you will be taken to a recovery room. If a catheter was placed, it usually stays in for a few hours or overnight to help drain urine and flush the bladder. It's common to see blood in your urine, which may appear pink, red, or even have small clots. This usually improves over a few days or weeks. You might also feel some discomfort or burning during urination and experience bladder spasms, which can feel like cramping. Most people stay in the hospital for one night, though some may go home the same day. Once home, it's important to rest and avoid heavy lifting or strenuous activities for about two to four weeks. Drinking plenty of fluids helps flush your bladder and reduce the risk of infection. Your doctor will advise you on when you can resume normal activities, including sexual activity. You will have a follow-up appointment with your doctor, usually within a few weeks, to discuss the pathology results from the removed tissue. This appointment is crucial for determining the next steps in your treatment plan, if any. It is important to contact your doctor if you experience heavy bleeding, fever, severe pain, or difficulty urinating.

Risks & side effects

While generally safe, TURBT carries some risks and potential side effects. Common issues include blood in the urine, bladder spasms, and discomfort during urination. More serious, though rare, complications can include urinary tract infections, heavy bleeding requiring a transfusion, bladder perforation (a hole in the bladder wall), or narrowing of the urethra (stricture).

As with any surgical procedure, TURBT has potential risks, though serious complications are uncommon. The most frequent side effects are temporary and include blood in the urine (hematuria), which can last for several days or weeks, and bladder spasms, which feel like cramping in the lower abdomen. You might also experience some pain or burning when you urinate. Less common but more serious risks include urinary tract infections (UTIs), which may require antibiotics. There is also a small risk of heavy bleeding that might necessitate a blood transfusion. A rare but serious complication is bladder perforation, where a small hole is accidentally made in the bladder wall during the procedure. This usually requires a temporary catheter or, in very rare cases, further surgery to repair. Another potential long-term complication is urethral stricture, a narrowing of the urethra that can make urination difficult. This is more likely if multiple TURBTs are performed over time. Your medical team will discuss these risks with you before the procedure and take precautions to minimize them.

Success rate

The success of TURBT is primarily measured by its ability to accurately diagnose bladder cancer and completely remove all visible tumors. While the procedure is usually successful in achieving these goals, bladder cancer, especially early-stage types, has a high chance of recurrence. Therefore, TURBT is often followed by regular surveillance or additional treatments to prevent the cancer from returning.

TURBT is highly effective in its primary roles: diagnosing bladder cancer and removing visible tumors from the bladder lining. For many people with non-muscle invasive bladder cancer (cancer that has not grown into the deeper muscle layer), a complete TURBT can be the main treatment. The goal is to remove all cancerous tissue and obtain clear margins, meaning no cancer cells are found at the edges of the removed tissue. However, it is important to understand that bladder cancer, particularly non-muscle invasive types, has a significant risk of returning (recurrence). Even if all visible tumors are removed, microscopic cancer cells might remain or new tumors might develop. This high chance of recurrence means that TURBT is often just the first step in managing bladder cancer. Because of the high recurrence rate, TURBT is often followed by additional treatments, such as intravesical therapy (medication placed directly into the bladder), and a strict schedule of follow-up cystoscopies (a procedure to look inside the bladder). This ongoing surveillance is crucial to detect and treat any new or recurring tumors early. The "success" of TURBT, therefore, is often part of a broader, long-term management strategy for bladder cancer.

Frequently asked questions

How long does a TURBT procedure usually take?

The duration of a TURBT can vary depending on the size and number of tumors. It typically takes between 30 minutes to 90 minutes. Your surgeon will give you a more precise estimate based on your specific case.

Will I have a catheter after TURBT?

Yes, it is common to have a thin, flexible tube called a catheter inserted into your bladder after a TURBT. This helps drain urine and sometimes continuously flushes the bladder. It is usually removed after a few hours or overnight.

When can I return to normal activities after TURBT?

You should plan to rest and avoid strenuous activities, heavy lifting, and sexual activity for about two to four weeks after a TURBT. Your doctor will provide specific guidance on when it is safe for you to resume your usual routine.

Is TURBT painful?

You will not feel pain during the TURBT procedure itself because you will be under general or regional anesthesia. Afterward, it's common to experience some bladder discomfort, burning during urination, or mild pain, which can usually be managed with medication.

What should I do if I see blood in my urine after TURBT?

Seeing blood in your urine (hematuria) is very common after a TURBT and can last for several days or even weeks. It may appear pink, red, or contain small clots. Drink plenty of fluids. However, if you experience heavy bleeding, large clots, or difficulty urinating, you should contact your doctor immediately.

Will I need more treatment after TURBT?

TURBT is often the first step in treating bladder cancer. Depending on the pathology results and the stage of your cancer, you may need additional treatments, such as medication placed into the bladder (intravesical therapy) or further surgery. Regular follow-up appointments are also crucial.

Sources

• MedlinePlus — TURBT
• Mayo Clinic — TURBT
• Cochrane Library — TURBT