Bladder cancer originates in the cells lining the bladder, a hollow organ in the lower abdomen that stores urine. The most common type begins in the urothelial cells, which form the inner lining of the bladder. Transurethral Resection of Bladder Tumor (TURBT) is often the initial procedure when bladder cancer is suspected or diagnosed, serving both diagnostic and therapeutic purposes.
What Is TURBT
Transurethral Resection of Bladder Tumor (TURBT) is a surgical procedure for bladder cancer performed through the urethra. A surgeon inserts a thin, rigid instrument called a resectoscope into the bladder. This instrument contains a camera to visualize the bladder’s interior and a wire loop or laser to remove abnormal growths. The primary purpose of TURBT is to remove visible tumors and obtain tissue samples for pathological examination.
This examination determines if cancer cells are present, their aggressiveness (grade), and depth of growth into the bladder wall (stage). TURBT is the main treatment for non-muscle invasive bladder cancer (NMIBC), where tumors are confined to the inner lining and have not spread into the deeper muscle layer. By removing these tumors and providing diagnostic information, TURBT guides subsequent treatment decisions for NMIBC.
Why Repeat Procedures Are Needed
Bladder cancer, particularly non-muscle invasive bladder cancer (NMIBC), has a high recurrence rate, often necessitating repeat TURBTs. Recurrence rates for NMIBC can be as high as 50-70% even after successful initial treatment. One reason for repeat procedures is to ensure complete tumor removal and accurate staging, known as a “second-look TURBT.” This second procedure is typically performed within 2-6 weeks after the initial TURBT, especially for high-risk tumors or if the initial resection was incomplete or lacked muscle tissue for proper staging.
Second-look TURBT helps identify residual tumor cells and confirms the depth of invasion, aiding in determining the risk of cancer returning or progressing. Beyond the second-look, ongoing surveillance TURBTs are common for long-term NMIBC follow-up. These regular procedures allow for early detection and removal of new or recurrent tumors, managing the disease effectively over time.
Deciding on Further TURBTs
There is no fixed limit to the number of TURBTs an individual can undergo, as the decision for further procedures is highly individualized. The choice depends on tumor characteristics, the patient’s overall health, and response to previous treatments. Tumors with higher grades, larger sizes, multiple occurrences, or high-risk features like carcinoma in situ (CIS) often warrant more frequent or repeated TURBTs.
The urologist considers the patient’s general health, ability to tolerate anesthesia, and any potential scarring or reduced bladder capacity from prior resections. If the bladder wall thins or capacity significantly decreases due to repeated procedures, alternative strategies may become necessary. Ultimately, the decision for another TURBT is a clinical judgment based on continuous monitoring and the patient’s specific cancer behavior.
Beyond TURBT When Necessary
When TURBT alone is no longer effective, or if bladder cancer progresses or recurs aggressively, other treatments are considered. Intravesical therapies involve delivering medication directly into the bladder through a catheter. These therapies, such as Bacillus Calmette-Guérin (BCG) immunotherapy or chemotherapy agents like mitomycin C or gemcitabine, destroy remaining cancer cells and reduce recurrence risk. BCG is often used for intermediate and high-risk NMIBC, while chemotherapy may be an alternative or used if BCG is ineffective.
For cases where NMIBC is aggressive, recurrent despite intravesical therapies, or progresses to muscle-invasive disease, more extensive surgical options may be necessary. Radical cystectomy, the surgical removal of the entire bladder, is a major procedure that may include removing nearby lymph nodes and reproductive organs. This approach is typically reserved when bladder-preserving treatments are insufficient to control the disease, indicating a shift to address more advanced or persistent cancer.