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Transurethral Resection of Bladder Tumor (TURBT)

Overview

TURBT is a surgical procedure primarily used to diagnose and treat bladder cancer. It involves the removal of tumors or abnormal tissue from the bladder through the urethra without needing an external incision. TURBT is the most common first-line treatment for non-muscle invasive bladder cancer (NMIBC), often followed by other therapies like chemotherapy or immunotherapy to reduce the risk of recurrence.
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How is Transurethral Resection of Bladder Tumor (TURBT) done?

Pre-operative Evaluation:
  • Detailed history and physical examination.
  • Cystoscopy: A diagnostic procedure where a camera is inserted into the bladder to assess the tumor's size, location, and number.
  • Imaging studies: CT urogram or MRI may be used to visualize the bladder and surrounding structures.
  • Blood tests: To evaluate kidney function and overall health.
  • Electrocardiogram (ECG): To assess heart function, especially in elderly patients.
Medications:
  • Anticoagulants (blood thinners) may be stopped a few days before surgery to prevent excessive bleeding.
  • Antibiotics may be given before the procedure to reduce infection risk.
Patient Instructions:
  • Patients are asked to fast 6-8 hours before surgery.
  • Bowel preparation may be required in some cases.
  • Hydration with intravenous fluids may be initiated.

Anesthesia:

General or spinal anesthesia is used, depending on the patient’s condition and the surgeon's preference.

Procedure:
  • The surgeon inserts a resectoscope (a thin tube with a light, camera, and wire loop) through the urethra.
  • The tumor is excised using the wire loop and the tissue is sent for pathological examination.
  • Cauterization may be performed to control bleeding.
  • Depending on the tumor's size and depth, chemotherapy (mitomycin or BCG) may be instilled into the bladder immediately after surgery.
Duration:
  • TURBT typically takes 30 to 90 minutes, depending on the complexity and number of tumors.
Post-operative Care:
  • A catheter may be placed in the bladder to allow urine drainage.
  • The patient is observed for bleeding or signs of infection.
  • The catheter is usually removed after 24 to 48 hours.

Though TURBT is generally safe, some potential complications include:
  • Bleeding: This is common post-surgery but usually resolves on its own.
  • Bladder perforation: Rare, but may require further surgery.
  • Infection: Urinary tract infections (UTIs) or bladder infections can occur.
  • Scar tissue formation: This can lead to urethral strictures or bladder contraction over time.
  • Recurrence: Bladder cancer has a high recurrence rate, and TURBT may need to be repeated.
What are the benefits TURBT?
  • Minimally Invasive: No external incisions are made, resulting in quicker recovery times.
  • Effective Diagnostic Tool: Helps assess the stage and grade of bladder cancer.
  • Curative for Early-Stage Tumors: Especially in non-muscle invasive bladder cancers.
  • Short Recovery Time: Most patients can return home the same day or within 24-48 hours.
  • Preservation of Bladder: Unlike other treatments that may involve bladder removal, TURBT preserves bladder function.

Infrastructure & Facilities

  • Well-Equipped Operating Room: Needs to be equipped for endoscopic procedures.
  • Availability of Cystoscopy and Imaging Facilities: For diagnosis and follow-up.
  • Pathology Laboratory: For analyzing tumor samples.
  • Intensive Care and Post-Operative Units: For monitoring patients post-surgery.
  • Infection Control and Sterile Equipment: Essential for minimizing the risk of post-operative infections.

FAQs

No, the procedure is done under anesthesia, so you won’t feel pain during it. Some discomfort or burning sensation while urinating may be felt afterward.

Most patients recover within 1-2 weeks, though some might need a longer time depending on the extent of surgery.

Yes, bladder cancer has a high recurrence rate, so regular follow-up cystoscopies are essential.

Light activities can be resumed within a few days, but strenuous activities should be avoided for at least 2-4 weeks.

In rare cases, bladder perforation may occur, and if small, it usually heals on its own. Larger perforations may require further surgical intervention.

In many cases of non-muscle invasive bladder cancer, intravesical chemotherapy (like mitomycin) or immunotherapy (like BCG) is recommended post-TURBT to reduce the risk of recurrence.

In many cases of non-muscle invasive bladder cancer, intravesical chemotherapy (like mitomycin) or immunotherapy (like BCG) is recommended post-TURBT to reduce the risk of recurrence.

Follow-up is essential, with cystoscopy typically repeated every 3-6 months in the first few years, then annually if no recurrence is detected.

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