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Transurethral resection of a bladder tumour (TURBT)

Transurethral resection of a bladder tumour (TURBT) is a procedure used to cut away any abnormal growths (tumours) that may have developed in your bladder. Any growths are then tested to see if they are cancerous and if they are, how advanced the cancer is. If the tumour is on the lining of your bladder and hasn’t grown down into the surrounding muscle (non-muscle invasive), TURBT can be an effective treatment.

There are other tests for bladder cancer, but TURBT is the recommended procedure to both diagnose and treat it.

Eight out of 10 people with bladder cancer have the non-muscle invasive type and so have TURBT as a form of treatment. After the procedure, you’re likely to be treated with medicine, either mitomycin C or Bacille Calmette-Guérin (BCG). It helps to get rid of any cancerous cells that might still be there and prevent the cancer from coming back.

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An image showing the location of the bladder and surrounding structures

Details

  • Preparation Preparing for transurethral resection of a bladder tumour

    Going to hospital for a procedure can be daunting, so understanding how to prepare can be useful.

    If you smoke, you’ll be asked to stop. Smoking may slow down your recovery after the procedure, as it can make you more at risk of getting an infection. Overall, stopping smoking is good for your health. But, as smoking is also linked to bladder cancer, further down the line, stopping can help prevent your cancer from coming back.

    You’ll have a general anaesthetic for the procedure so you’ll be asked not to have food or drink for around six hours beforehand. It’s important you follow this advice as, if not, it may complicate your procedure.

    Depending on the size of your cancer and where it is, you might have to stay for between one or two days in hospital. Try to plan in advance for somebody else to take care of any everyday tasks that you’d usually need to do, such as feeding pets.


    It may be helpful to make some preparations for when you get home afterwards. You could:

    • have some convenient and nutritious meals pre-prepared and frozen
    • put small bottles of water around your home as a reminder to keep drinking fluid— It’ll help you to flush your bladder out after surgery
    • clear your home of any obstructions, so you aren’t tempted to do any heavy lifting

    You’ll meet with your surgeon before the procedure. Be sure to ask any questions you have, so that you feel confident about what’s going to happen. Understanding your surgery is important, as you’ll be asked to sign a consent form to allow the procedure to go ahead. It might help to prepare your questions in advance, writing them down as and when you think of them.

    You should be asked, but if not, tell your surgeon about any other medicines you may be taking. It’s important you do this as some can interfere with those used during surgery. From this, you’ll be advised on how you should take your usual medication.


    On the day, you’ll be prepared for surgery. This will include:

    • a check of your general fitness
    • taking antibiotics to stop you getting any infections from the procedure
    • putting on compression stockings and potentially having an injection of an anti-clotting medicine (heparin). Both of these help to prevent blood clots forming in the veins of your legs

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  • Alternatives What are the alternatives to transurethral resection of bladder tumour?

    There are no exact alternatives to TURBT. This procedure is one of the first steps for diagnosing and treating bladder cancer.

    You may hear of other ways to investigate if you have bladder cancer, such as:

    • testing your urine, for example, for cancer cells
    • using a CT scan or ultrasound to make an image of your bladder
  • The procedure What happens during transurethral resection of a bladder tumour?

    Depending on the size and how many tumours you have, the operation can take between 15 and 40 minutes.

    During the procedure your surgeon passes a cystoscope (a thin, tube-like telescope) along your urethra (the tube that passes urine out of your body). They will then feed this up into your bladder. A camera lens at the end of the cystoscope sends pictures from the inside of your bladder to a monitor. This allows your surgeon to see any unusual growths on your bladder wall. Your surgeon then passes a wire loop along the side of the cystoscope. This loop has a safe electrical current passing through it, which creates heat. Using this, your surgeon guides the tumour away from your bladder wall and in the process, seals the area to stop any bleeding.

    Your surgeon will also remove some deeper tissue. Sometimes, cancerous lumps can grow outwards or into the muscle layer of your bladder (muscle invasive bladder cancer). This is less common than the non-muscle invasive type, but testing the deeper tissue can confirm whether or not this has happened.

    Any growths or samples of bladder tissue that are removed during the procedure are sent to the laboratory for testing.

    Your surgeon then takes the cystoscope out and passes a thin, flexible tube (catheter) into your urethra. Your catheter will allow you to pass urine. It’s also used to flush your bladder through after the procedure and give you the chemotherapy medicine mitomycin C. It will normally be left in place during your stay in hospital.

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  • Aftercare What to expect afterwards

    After your surgery you’ll rest until the effects of your anaesthetic have worn off.

    Your nurse will keep an eye on you; monitoring your blood pressure and heart rate. They’ll also check your catheter and flush your bladder through, washing away any blood or clots of blood from surgery. This is called bladder irrigation.

    Shortly after your procedure, your doctor puts the chemotherapy medicine (mitomycin C) into your bladder through your catheter. It’s left in your bladder for up to a couple of hours. The medicine:

    • destroys any remaining cancer cells
    • helps to stop your cancer from coming back

    You’re likely to need to stay in hospital for around two or three days. When you feel ready, get up and take a short walk around – there will be healthcare staff that can help you. This will help to keep your blood flowing around your body properly.

    After surgery you’ll have blood in your urine – this should ease up as your bladder is flushed through. Make sure you also drink plenty of water to help this process along. When your urine is free of blood, your catheter will be removed and you can probably go home. Removing the catheter might cause you a little discomfort, but shouldn’t cause you any pain.

    Once your catheter is removed you may have some trouble urinating and when you do, you might get a mild burning sensation. Try to relax as much as you can and it should become easier.

    Before you leave hospital, you’ll be given a date for a follow-up appointment where the results from your surgery will be discussed with you. When you leave, try to arrange for someone to drive you home. And if you can, have a friend or relative stay with you for the first 24 hours or so.

    You might notice some bleeding a couple of weeks after surgery. This will be any scabs from surgery coming away from your bladder wall and being flushed out in your urine. If bleeding continues or is noticeably heavier, get in touch with your doctor for advice.

    You may need to have another TURBT. Sometimes during the procedure, as your surgeon will be careful not to damage your bladder, the sample taken might miss the area below your growth. Having another TURBT makes sure that a sample from this area is taken, so that your diagnosis is as accurate as can be.

    Depending on the results you may need to have additional treatment. You’ll probably also need to have follow-up tests to keep an eye on your bladder. How often you have these will depend on what was found in your first TURBT.

  • Recovery Recovering from transurethral resection of a bladder tumour

    After surgery it’s important that you follow your surgeon’s advice. Take time to recover properly– trying to do too much too soon may mean it ends up taking longer. We’ve put together some practical advice of ways you can help make your recovery as smooth as possible.


    • Drink plenty of water. This will help wash away any blood or bacteria in your bladder and reduce your risk of getting a urine infection.
    • If you have been prescribed antibiotics, make sure you complete the full course. Even though you may feel better after a short time, the bacteria may still be there and could start to grow again.
    • Eat a healthy, well-balanced diet. Your bladder will need to repair itself after surgery, so eating nutritious foods like fruit and vegetables can help. You should also eat high-fibre foods to help prevent constipation. If you’re constipated, this can put pressure on your bladder and cause increased bleeding. High-fibre foods include wholegrain cereals, whole wheat pasta and brown rice.
    • Don’t do any heavy lifting, strenuous exercise or driving in the first two weeks after your surgery. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations.
    • If you smoke, it’s important to stop as this will help reduce the risk of your bladder cancer coming back.
    • If you find that you need pain relief, take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
  • Side-effects What are the side-effects of TURBT?

    Side-effects are the unwanted but mostly temporary things you may get after having a procedure. In TURBT they may include:

    • discomfort and difficulty passing urine – this usually settles shortly after the procedure
    • blood in your urine – this is helped by drinking plenty of water to flush out your bladder
  • Complications What are the complications of TURBT?

    Complications are the more serious and unexpected problems that may occur during or after your procedure. The possible complications of any operation include an unexpected reaction to the anaesthetic or developing a blood clot in your leg (deep vein thrombosis).

    Possible complications of TURBT are outlined below. If you have any of the symptoms described, make sure you contact your doctor immediately.

    • Urine infection. Bacteria can enter your urinary tract and cause infection either during surgery (as the cystoscope is inserted) or afterwards (when your catheter is put in place). If you have a urine infection, you’ll find you need to urinate more frequently and with more urgency than usual. You may get a burning sensation when you pass urine and you may notice that it smells quite unpleasant. You’re also likely to have a fever (a temperature higher than 38°C). If you have a urine infection, you’ll be treated with a course of antibiotics.
    • Perforation. Your surgeon will take samples from the muscle layer of your bladder. When doing this there is a chance of your surgeon making small holes in your bladder wall (perforations). Perforations can be small, healing on their own and causing no harm. You’ll probably see blood in your urine as they heal. It’s rare but some people can have large perforations that need surgery to repair them. If so, you’ll have heavy blood-stained urine and severe pain.
    • Incomplete removal or return of your growths. Sometimes not all growths are removed during TURBT. They may also come back afterwards. In both cases it’s likely that you’ll need to have another TURBT procedure.
  • I don't want to have TURBT What happens if I don't want to have TURBT?

    Answer

    Although there are no exact alternatives, your surgeon will recommend the next best treatment for you.

    More information

    It’s really important that you understand why you’re being asked to have the procedure. TURBT is an essential first step in diagnosing and treating bladder cancer. If you choose not to have it, your doctor won’t know for sure if you have bladder cancer or not. If you do have bladder cancer, they will also not know what type it is or how best to treat you.

    TURBT is also the recommended way to remove bladder cancer that hasn’t advanced too far into your bladder. Without it the cancer will stay in your bladder, where it could grow and spread (metastasise).

    If you decide not to have TURBT, bladder cancer could be diagnosed by testing your urine for cancerous cells, but it’s not always reliable. Testing your urine for special markers is another option, but using these instead of TURBT isn’t recommended.

    You’re free to choose not to have the recommended treatment or any treatment at all. You don’t have to give any reasons for your decision but it can help your surgeon to know your concerns. This will allow them to give you the best advice. Make sure you ask any questions you have and you can always ask for more time to decide about the treatment if you feel you need it.

  • Other helpful websites Other helpful websites

    Further information

    Sources

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    • Renal medicine and urology. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published March 2014
    • Bladder cancer. Medscape. www.emedicine.medscape.com, published April 2014
    • Bladder cancer: diagnosis and management. National Institute for Health and Care Excellence (NICE), published 25 February 2015. www.nice.org.uk
    • Kiselyov A, Bunimovich-Mendrazitsky S, Startsev V. Treatment of non-muscle invasive bladder cancer with Bacillus Calmette-Guerin (BCG). BBA Clinical 2015; 4:27–34. doi:10.1016/j.bbacli.2015.06.002
    • Electronic Medicines Compendium (eMC). www.medicines.org.uk, reviewed December 2013
    • Smoking cessation before surgery doesn’t promote post operative complications. Medscape. www.emedicine.medscape.com, accessed July 2015
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    • Bladder tumour resection. The British Association of Urological Surgeons. www.ouh.nhs.uk, accessed July 2015
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    • Transurethral resection of bladder tumours: overview of TURBT. Medscape. www.emedicine.medscape.com, reviewed July 2013
    • Alsaywid B, Smith B. Antibiotic prophylaxis for transurethral urological surgeries: systematic review. Urol Ann 2013; 5(2):61–74. doi: 10.4103/0974-7796.109993
    • Surgical site infection. National Institute for Health and Care Excellence (NICE), published October 2013. www.nice.org.uk
    • Richards K, Smith N, Steinberg G. The importance of transurethral resection of bladder tumour in the management of non-muscle invasive bladder cancer: a systematic review of novel technologies. J Urol 2014; 191(6):1655–64. doi: http://dx.doi.org/10.1016/j.juro.2014.01.087
    • Leopardo D, Cecere S, Napoli M. Intravesical chemo-immunotherapy in non-muscle invasive bladder cancer. Eur Rev Med Pharmacol Sci 2013; 17:2145–58
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    • Guidelines on non-muscle invasive (Ta, T1, CIS) bladder cancer. European Association of Urology. www.uroweb.org, reviewed April 2014
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    • Personal communication, Mr Raj Persad, Consultant Urologist, The Glen Hospital, Bristol, 7 October 2015
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