Transurethral Resection of Bladder Tumor (TURBT)

Transurethral Resection of Bladder Tumor (TURBT) – Complete Guide

Transurethral Resection of Bladder Tumor (TURBT) is the primary diagnostic and therapeutic procedure for non-muscle-invasive bladder cancer (NMIBC). It involves removing visible tumors from the bladder lining using a specialized instrument inserted through the urethra.

Key Purposes of TURBT

1. Diagnosis – Confirms tumor presence, stage (Ta, T1, CIS), and grade (low/high).
2. Treatment – Removes visible tumors to prevent progression.
3. Risk Stratification – Guides further therapy (chemo/immunotherapy vs. cystectomy).

Procedure Steps

1. Anesthesia: Spinal or general anesthesia.
2. Cystoscopy: A resectoscope (thin tube with a camera & loop electrode) is inserted via the urethra.
3. Tumor Removal:
   1. The tumor is shaved off in layers using an electrified loop.
   2. Deep samples are taken to check for muscle invasion.
4. Fulguration: The base is cauterized to stop bleeding.
5. Pathology: Tissue is sent for microscopic analysis.

Duration: Typically 30–60 minutes.

Post-TURBT Recovery

• Hospital Stay: Usually outpatient (home the same day).
• Catheter: Sometimes placed for 1–2 days (if bleeding risk).
• Side Effects:
  • Blood in urine (hematuria) for a few days.
  • Burning during urination (1–2 weeks).
  • Urinary frequency/urgency.
• Restrictions: Avoid heavy lifting/sex for 1–2 weeks.

Complications (Rare but Possible)

Why is TURBT Critical?

• Incomplete resection → Higher recurrence.
• Muscle invasion missed → Delayed radical treatment.
• Determines next steps:
  • Low-risk Ta: Single chemo dose (Mitomycin C).
  • High-grade T1/CIS: BCG immunotherapy or re-TURBT.
  • Muscle invasion (T2+): Radical cystectomy.

Second TURBT (Re-TUR) – When is it Needed?

• High-grade T1 tumors (up to 50% have residual cancer).
• Incomplete initial resection.
• No muscle in initial specimen (risk of understaging).
• Performed 2–6 weeks after first TURBT.

Alternatives to Standard TURBT

1. En-bloc Resection – Removes tumor in one piece (better for small tumors).
2. Blue-Light Cystoscopy (Cysview®) – Enhances tumor detection with fluorescent dye.
3. Narrow-Band Imaging (NBI) – Improves visualization of abnormal blood vessels.

Takeaway

• TURBT is essential for diagnosing and treating early bladder cancer.
• Quality of resection impacts recurrence risk.
• High-risk cases often need a second TURBT or BCG.