The Transurethral Resection of Bladder Tumor (TURBT) is a minimally invasive surgical procedure used for both the diagnosis and initial treatment of bladder cancer. This procedure involves removing suspicious growths or tumors from the inner lining of the bladder. The surgeon accesses the bladder wall through the urethra, avoiding an external incision. For many patients, especially those with early-stage disease, the TURBT is the first step in their treatment plan and provides essential information about the disease.
The Dual Purpose of TURBT
The TURBT procedure serves two functions: diagnosis and therapy. Diagnostically, the goal is to obtain tissue samples for analysis by a pathologist. This analysis confirms the presence of cancer, determines the tumor’s grade (how abnormal the cells appear), and establishes its stage (how deeply it has invaded the bladder wall). Accurate staging requires the removed specimen to include a portion of the detrusor muscle, the muscular layer of the bladder wall.
The therapeutic role of TURBT focuses on removing all visible tumor masses within the bladder. For most early-stage bladder cancers, this initial resection may be the only surgical treatment required. Eradicating the tumor while preserving the bladder allows for subsequent non-surgical therapies or surveillance. The information gained from the tissue analysis guides all subsequent treatment decisions.
What Happens During the Procedure
The TURBT is performed in a hospital or surgical center under general or spinal anesthesia. The patient is positioned with their legs in stirrups, known as dorsal lithotomy. Before the resection begins, the surgeon may perform a bimanual examination to assess the bladder and surrounding structures.
A specialized instrument called a resectoscope is inserted through the urethra and advanced into the bladder. This long, thin tube contains a camera, a light source, and a working channel, allowing the surgeon to view the bladder lining on a monitor. Once the tumor is located, the surgeon uses an electrified wire loop on the resectoscope to shave off the tumor tissue in small pieces. The removed tissue is collected and sent for pathology analysis.
After the tumor is removed, the surgeon uses the resectoscope to cauterize the base of the resection site. This process, called fulguration, uses heat or energy to seal blood vessels and minimize post-operative blood loss. The entire procedure generally lasts less than one hour, depending on the number and size of the tumors.
Immediate Recovery and Post-Operative Care
Following the procedure, patients are monitored in a recovery area as the effects of anesthesia wear off. Many patients are discharged the same day, though an overnight stay may be required if the tumor was large or bleeding is excessive. A urinary catheter is often temporarily placed in the bladder to drain urine and allow for continuous irrigation to prevent blood clot formation.
The catheter is usually removed once the urine is clear of significant bleeding. It is common to experience hematuria, or blood in the urine, which may appear pink or red for several days or up to a few weeks after surgery. Patients may also notice increased frequency or urgency of urination, along with a burning or stinging sensation. This discomfort typically improves as the bladder lining heals.
Pain management is achieved with prescribed or over-the-counter medication. Patients are advised to increase their fluid intake to help flush the bladder and reduce irritation. For approximately two to three weeks, patients must avoid strenuous activities, heavy lifting, and anything that causes straining to prevent new bleeding at the surgical site.
Pathology Results and Surveillance Planning
The tissue samples removed during the TURBT are sent to a laboratory for examination by a pathologist. This analysis provides details that determine the next steps in the patient’s care. The report specifies the tumor’s grade (low-grade tumors are slower growing, high-grade tumors are more aggressive) and its stage (the depth of invasion).
Bladder cancer is categorized based on staging as either non-muscle invasive or muscle-invasive. Non-muscle invasive disease is confined to the inner lining, while muscle-invasive disease has penetrated the detrusor muscle layer. The pathology results, including the presence or absence of detrusor muscle in the specimen, dictate the risk of cancer recurrence and progression.
Patients with high-grade or T1 tumors, which invade the layer beneath the inner lining, often require a second TURBT a few weeks later for complete removal and accurate staging. Regardless of the initial findings, a surveillance plan is necessary because bladder cancer has a high recurrence rate. This plan involves scheduled cystoscopies, where a thin scope is used to check the bladder for any new tumor growth.