Transurethral Resection of Bladder Tumor (TURBT)

November 25, 2024

This page was reviewed under our medical and editorial policy by Kevin G. Chan, M.D., clinical professor, division of urology and urologic oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

Transurethral resection of a bladder tumor (TURBT) may also be referred to as a bladder resection or a transurethral resection (TUR). It helps doctors look for bladder cancer. It is also commonly the first treatment for bladder cancer in the early stages, when the organ’s muscle layer is not involved.

What Is TURBT?

TURBT is a procedure used to look for cancer in the bladder or remove early-stage cancers. If the surgeon finds a growth (tumor), he or she may remove it or obtain tissue samples and examine them under a microscope.

The samples are used to confirm a bladder cancer diagnosis and pinpoint whether it is only on the outer surface (superficial) or if it has spread to deeper layers of the bladder wall, such as connective tissue or muscle.

This information helps doctors understand the cancer’s stage and plan treatment.

TURBT Procedure

TURBT is usually an outpatient procedure performed in a hospital or surgical center. Most patients go home the same day.

How Do Patients Prepare for a TURBT?

The surgical team will provide instructions on what to do before and after the procedure, and it is important to follow them carefully to avoid complications.

General instructions may include the following.

Certain medications, such as blood thinners, diabetic medications, pain medications, nicotine, alcohol or cannabis-containing drugs may need to be adjusted or stopped temporarily before surgery. It is important to tell the doctor about all medications, including over-the-counter medications, supplements and herbal remedies.

The surgeon may also ask the patient to:

• Stop eating or drinking at a specified time beforehand, often after midnight on the day of the procedure
• Take regular morning medications with a sip of water. Patients who take medications several times daily should bring them in the original bottle and check with their provider before taking them
• Arrange for someone else to drive them home, and stay with them for the first 24 hours
• Take a shower on the morning of the surgery (possibly with a special antiseptic soap)
• Avoid using scented deodorants or moisturizers before the procedure
• Wear comfortable clothing

How Is the Procedure Performed?

Patients receive medication (anesthesia) just before the TURBT so they will not feel any pain. Patients will either be asleep (general anesthesia) or awake but numb below the waist (regional or spinal anesthesia). A spinal anesthetic is given through a small flexible tube inserted in the back, between the thin tissue layers protecting the spinal cord. These patients may also receive intravenous (IV) medications to help them relax.

For the procedure, the surgeon uses a special instrument called a resectoscope, a small, thin tube with a built-in camera and light. It is inserted into the body through the urethra (the tube through which urine leaves the bladder and exits the body), so no incision in the abdomen is needed.

The resectoscope has a wire-like tool with an adjustable loop at the end that uses an electric current to reach high temperatures. The surgeon uses this instrument to look at the inside of the bladder. If a tumor or abnormal tissue is seen, the surgeon uses the wire loop to remove it or take a sample, and then apply heat to the area to stop bleeding (cauterize).

The surgeon may take steps to treat any cancerous areas after taking samples, either by burning the tumor area using the heated wire or by inserting a laser tool through the rectoscope to destroy any remaining cancer cells. This is called fulguration.

After removing the resectoscope, the surgeon may insert a catheter (a soft, flexible tube) into the urethra to help the bladder drain more easily and prevent blockages from blood clots.

Some surgeons add an extra step to the procedure called blue light cystoscopy. This advanced approach involves a special dye, which goes into the bladder through a catheter. After an hour, the solution causes bladder cancer cells to glow bright pink or red when viewed with a blue light, making it easier for the surgeon to see and remove them.

How Long Does the TURBT Procedure Take?

The procedure typically takes 15 to 90 minutes, depending on what the surgeon finds and how much treatment is required.

Patients may also be asked to arrive two hours before the surgery, and they will need time for recovery after. Patients may remain in recovery for a few hours, depending on the type of anesthetic and their response.

After the procedure, it is important to drink lots of fluids to help flush the bladder.

Patients react to anesthetics differently. The care team will assess the factors below before discharging each patient to be certain that:

• Blood pressure, heart rate, breathing and oxygen levels have returned to preoperative levels
• The patient is able to eat and drink without vomiting
• The patient is able to urinate (this will be different if the patient has a catheter)
• The patient is awake, alert and knows where he or she is
• The patient is able to get up on his or her own

Before the patient goes home, a member of the health care team will go over instructions for what to expect during recovery and when to call with any concerns.

How Many Times Can You Have TURBT for Bladder Cancer?

If cancer cells are found during the initial TURBT, a second, more extensive procedure may be scheduled two to six weeks later.

Repeated TURBT or cystoscopies may cause scarring in the bladder, which may lead to frequent urination or leakage. It may also increase the risk of complications.

TURBT Recovery

Recovery times vary for each patient, depending on factors such as age, overall health and any complications that emerge. Many patients fully recover after a few weeks. The surgeon provides written instructions on what to do for a healthy recovery. These may include the following.

Activity

Patients should rest and relax and sleep when needed.

In the first few weeks:

• Avoid heavy lifting or straining.
• Do not engage in sexual activity.
• Stay home from work.
• Driving may be limited.
• Avoid prolonged sitting.

After the first few weeks:

• Gradually increase lifting.
• Limited sexual activity may be resumed.
• Return to work gradually, with a reduced workload or hours.
• Drive as usual.

Diet

Following a nutritious diet will help the body heal more quickly.

• Initially, drink eight to 10, 8-ounce glasses of water each day to help flush the bladder.
• Avoid constipation with added dietary fiber or stool-softening medications.

Pain

Some pain is normal after a TURBT and is usually associated with burning on urination (dysuria); a sudden, strong urge to urinate (urgency); or needing to urinate often but only in small amounts (frequency). This discomfort usually settles down in the first few weeks.

In the first few weeks:

• Avoid alcohol while taking any medications that cause sleepiness or dizziness.
• Only take the medications the doctor has prescribed for pain.
• To ease discomfort, place a warm cloth over the urethra opening or, if you do not have a catheter, take a warm bath.

After the first few weeks:

• Follow the doctor’s instructions for starting back on blood thinning medications that were stopped before surgery.
• After checking with the doctor, pain may be treated with ibuprofen, aspirin or acetaminophen medications.

Alcohol

Alcohol use has been linked to complications before and after surgery. It has been shown to increase the tendency to bleed, to slow wound healing and increase the risk of infection.

For these reasons, avoiding alcohol for two to four weeks before surgery and up to five weeks afterward is recommended.

If a patient has any issues with alcohol use, he or she should discuss these with his or her doctor before surgery to avoid complications from alcohol withdrawal.

Catheter

Some patients may go home with a catheter attached to a drainage bag. A member of the health care staff will give instructions for caring for it at home. These recommendations include:

• Clean gently around the area where the catheter enters the body using warm water and mild soap.
• Secure the tube connecting the catheter with the bag to the thigh to avoid accidentally pulling it out.
• Avoid kinks in the tubing.
• Wear loose pants with wider legs to fit around the bag.
• Consider using a smaller bag (leg bag) during the day and a larger one at night.
• Keep the drainage bag below the bladder to keep urine from draining back into the bladder.

TURBT Complications

Some of the complications associated with TURBT may include the following.

Reaction to anesthetic. Some patients may have an allergic reaction to the medication, or have difficulty breathing.

Blood in the urine. It may come and go in the first three to six weeks and may include small blood clots. Sometimes bleeding comes back in the first three weeks. This happens when the scab comes off the bladder wall and is a normal part of healing.

Bladder spasms. These may happen if the bladder wall is irritated, but this usually settles down after a few days.

Urinary tract infections. These may follow the procedure. Symptoms may include fever, pain when urinating (dysuria), constant need to urinate (frequency) and leaking urine (incontinence). The surgeon may prescribe antibiotics to take after the procedure to help avoid this.

Perforation. A hole in the bladder wall (perforation) is possible, but rare.

Bruising. This may happen at the urethra (where the urine leaves the body).

Some of these symptoms may settle on their own, but some may require calling the patient’s health care team, such as:

• Fever or chills
• Inability to urinate or only able to urinate in small amounts
• Large blood clots
• Increased bleeding in urine or around the catheter site
• Pain that is not controlled with prescribed pain medication
• Symptoms of urinary tract infection, such as burning, frequent or difficult urination
• Lower back pain or lower belly pain
• Confusion, typically in older patients