Transurethral resection of bladder tumor (TURBT)

Overview

Transurethral resection of bladder tumor (TURBT) is a procedure used to diagnose and treat bladder cancer. During TURBT, healthcare providers insert a specialized instrument called a cystoscope, which is a long, slender tube equipped with a camera, through the urethra to access the bladder. This approach eliminates the need for surgical incisions. Using the cystoscope, the healthcare provider locates and removes the bladder tumor. The removed tumor is then sent to a laboratory for pathological examination, which helps determine the stage and grade of the cancer. The stage indicates the depth of tumor infiltration into the bladder wall, while the grade assesses the abnormality of the tumor cells compared to normal cells.

Patients typically experience mild discomfort or pain for one to two weeks following the TURBT procedure. This post-operative discomfort is usually manageable with medication and proper care. The procedure itself is crucial for both diagnosing the extent of bladder cancer and treating it by removing the tumor. By providing essential information on the cancer’s progression and cellular characteristics, TURBT plays a significant role in guiding further treatment decisions and improving patient outcomes.

Reasons for undergoing the procedure

Patients undergo transurethral resection of bladder tumor (TURBT) when their healthcare provider needs to biopsy and/or remove a bladder tumor. This approach allows for both tasks—tissue sampling (biopsy) and tumor removal—to be completed efficiently in a single procedure.

Risk

Biopsy and resection of bladder tumors are generally safe procedures. However, like any surgery, they carry potential risks, such as:

• Risks associated with anesthesia, such as allergic reactions and respiratory issues.
• Urinary tract infections (UTIs).
• Excessive bleeding or prolonged bleeding.
• Possible injury to the bladder.

Before the procedure

Before undergoing TURBT, your healthcare provider will provide specific instructions on preparation. Following these instructions closely can help minimize the risk of complications. Prior to the procedure, your healthcare provider may ask you to:

• Refrain from eating for at least eight hours before the procedure (fast).
• Follow instructions regarding medications—either abstain from taking them or only take them with a small sip of water. Do not discontinue medications unless instructed by your healthcare provider.
• Arrange for transportation home after the procedure as you may not be able to drive.
• Take a bath or shower before the procedure, avoiding lotions, perfumes, or deodorants on that day.
• Inform your healthcare provider about all medications you are taking, including over-the-counter (OTC) and herbal supplements.

On the day of the procedure, wear comfortable clothing as you will need to change into a gown before it begins.

During the procedure

Before a TURBT procedure, your healthcare provider may administer general anesthesia, which will put you to sleep. Alternatively, some providers might use regional (or spinal) anesthesia, which numbs the lower part of your body while keeping you awake.

Sometimes, around an hour before surgery, your healthcare provider will insert a particular dye into your bladder through a catheter. This usually happens in the preoperative area. During the procedure, a specific light is used to illuminate the dye and facilitate tumor visualization, which makes the tumor easier to see.

To conduct a transurethral resection of bladder tumor (TURBT), your surgeon will carefully:

• Insert a scope into your bladder through the urethra.
• Identify and excise the tumor using a small cutting device, which will be examined by a pathology lab post-procedure.
• Apply heat to cauterize any bleeding at the resection site.
• Withdraw the scope and, if necessary, insert a catheter to drain urine and other fluids from the bladder, preventing blood clots. Your provider may also use the catheter to irrigate your bladder with saline (a sterile salt solution). Not everyone requires a catheter.

After the procedure

During a TURBT procedure, you should not feel pain. However, afterward, you may experience discomfort or pain, particularly during urination, for about a week or two.

Chemotherapy might be required in certain situations after TURBT. If the tumor has not moved outside of your bladder, your healthcare provider may recommend intravesical chemotherapy, which involves getting medication into your bladder through a catheter. After the tumor is removed, they might apply chemotherapy inside the bladder to give the first dose during the TURBT surgery. The weeks after TURBT would mark the start of further treatments.

After TURBT, healthcare providers will monitor you at the hospital for several hours. If you have a catheter, they may remove it before you leave, or it may remain for a few days afterward, depending on the tumor size and urine clarity. Once you are home, remember to:

• Follow your provider’s advice to drink plenty of fluids.
• Resume your normal diet and drinking habits.
• Wait for your healthcare provider to contact you with the biopsy results or to schedule a follow-up appointment. Find out how and when you should expect to receive the results by asking your provider.

Outcome

The primary advantage of TURBT is its capability to biopsy and treat tumors confined within the bladder without spreading. This approach minimizes the necessity for multiple procedures and reduces associated risks.

Recovery from a TURBT procedure can take up to six weeks until you feel fully restored. During the initial one to two weeks after the procedure

• Ensure to get enough rest.
• You may experience pain or a burning sensation when urinating. Your healthcare provider can advise on managing any discomfort.
• It’s normal to observe a small amount of blood in your urine, but inform your provider if you notice more than expected.
• Avoid straining or lifting heavy objects, and your provider may also advise against driving.

Your healthcare provider will inform you when you can expect to resume your normal level of activity. Typically, they advise waiting at least two weeks before gradually easing back into your usual activities.

Before or after your procedure, contact your healthcare provider with any questions. Inform them promptly if you experience:

• Fever.
• Urine that is bloody, cloudy, or has a foul odor.
• Unexpected or severe pain.
• A significant amount of blood in your urine.
• Large blood clots in your urine.