Transurethral Resection of Bladder Tumor (TURBT)

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

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

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

Duration: Typically 30–60 minutes.

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.

Complication	Frequency	Management
Bladder perforation	1–5%	Catheter or surgery if severe
Bleeding (severe)	1–3%	Blood clots may require irrigation
UTI	5–10%	Antibiotics if symptomatic
Urethral stricture	Long-term risk	May need dilation

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.

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