My clinical approach
TURBT is the procedure that defines a bladder cancer patient’s entire management pathway. Performed correctly — with complete resection, detrusor muscle included in the specimen, and systematic mucosal mapping — it provides all the information needed for the right strategy. Performed inadequately, the patient faces repeat procedures and potentially under-staging.
The quality of TURBT determines disease outcome more than anything else in non-muscle-invasive bladder cancer.
What is TURBT?
TURBT (Transurethral Resection of Bladder Tumour) is an endoscopic surgical procedure in which a resectoscope is introduced through the urethra and removes tumour tissue from the bladder mucosa and wall. It simultaneously serves three purposes:
When is TURBT indicated?
- Visible bladder tumour on cystoscopy
- Haematuria with suspicious lesion on imaging
- Positive urine cytology with negative initial cystoscopy (random biopsies)
- Re-TURBT after incomplete initial resection or T1 high-grade
Bladder cancer staging
Non-invasive papillary carcinoma
Confined to mucosa. Treated with TURBT + intravesical therapy based on risk group.
Lamina propria invasion
Invades submucosal connective tissue but not muscle. High risk — requires re-TURBT and BCG.
Carcinoma in situ
Flat, high-grade, non-invasive. High progression risk. Treated with BCG.
Muscle-invasive cancer
Invades detrusor muscle or beyond. TURBT confirms invasion — treatment is radical cystectomy or bladder-preserving protocol.
Pre-operative preparation
Pre-operative tests
Full blood count, biochemistry, coagulation, ECG, anaesthesiologist assessment.
Anticoagulants
Anticoagulants and antiplatelet agents are stopped or modified as per guidelines, typically 5–7 days before.
Fasting
Fast from midnight before surgery (or at least 6 hours).
Antibiotics
Prophylactic antibiotics are usually given before the procedure.
How the procedure is performed
Recovery and hospitalisation
During hospitalisation
Bladder irrigation via catheter for 12–48 hours depending on bleeding. Urine monitoring.
Catheter removal
Usually 1–2 days post-op, once urine clears.
At home
Increased fluid intake, avoid heavy exercise, avoid intercourse for 3–4 weeks. Avoid swimming.
Return to work
Desk work: 1–2 weeks. Physical work: 3–4 weeks.
Contact your urologist immediately if:
- Fever > 38.5°C
- Heavy haematuria with clots or catheter obstruction
- Severe abdominal pain
- Inability to urinate after catheter removal
Second TURBT (re-TURBT)
In selected cases, EAU recommends a second TURBT within 2–6 weeks. Indications for re-TURBT:
- Incomplete initial resection (large or multiple tumours)
- Absence of detrusor muscle in the specimen
- T1 high-grade — to exclude deeper invasion
- High-grade Ta
Studies show that in T1G3 tumours, re-TURBT reveals residual or upstaged cancer in 30–55% of patients. Re-TURBT is not a failure — it is evidence-based strategy to avoid under-staging.
Intravesical therapy after TURBT
Immediate post-operative intravesical chemotherapy
A single instillation of chemotherapy (usually mitomycin C or epirubicin) within 24 hours of TURBT. Recommended for low and intermediate-risk NMIBC — reduces recurrence risk by 35–40%.
BCG (Bacillus Calmette-Guérin) intravesical immunotherapy
The most effective intravesical therapy for intermediate and high-risk NMIBC (T1, high-grade Ta, Tis). Administered as weekly instillations for 6 weeks (induction), followed by 1–3 years maintenance. Significantly reduces recurrence and progression risk.
Frequently Asked Questions (FAQ)
What happens to the tissue removed during TURBT?
The tissue removed during TURBT is mandatorily sent for histopathological examination. This is essential for tumour staging, grading, and determining whether the cancer has invaded the muscle layer (T2) or remains superficial (Ta, T1, Tis).
How many days of hospitalisation are required?
Typically 1 to 3 days. A urinary catheter is placed after surgery for bladder irrigation and haemorrhage monitoring. For small, simple low-risk lesions, some patients go home the same day or the next day.
When is a second TURBT (re-TURBT) needed?
According to EAU 2024 guidelines, re-TURBT is recommended when: (a) initial resection was incomplete, (b) detrusor muscle is absent from the pathological specimen, (c) T1 high-grade tumour, (d) the urologist considers complete resection was not achieved. It is typically performed 2–6 weeks after the initial procedure.
When can I return to work?
For desk work, usually 1–2 weeks. For physical work, 3–4 weeks or as advised by your urologist. Avoid strenuous exercise and swimming for at least 3–4 weeks.
What anaesthesia is used?
TURBT is performed under spinal or general anaesthesia. The choice depends on the patient, the anaesthesiologist, and individual procedure characteristics. Spinal anaesthesia also allows neuromuscular response monitoring during electrosurgery.
What is BCG therapy and why is it used?
BCG (Bacillus Calmette-Guérin) is an immunostimulatory therapy instilled intravesically after TURBT in intermediate and high-risk NMIBC patients. It significantly reduces the risk of recurrence and progression. It is administered as weekly instillations for 6 weeks (induction), followed by maintenance therapy.
Can bladder cancer come back?
Yes. Non-muscle-invasive bladder cancer has a high recurrence rate (30–70% depending on type). This is why regular cystoscopy surveillance is essential. Early detection of recurrence allows re-resection before further progression.
Book your appointment in Rhodes
If you need TURBT or post-bladder cancer surgery surveillance, timely assessment by a specialist urologist is the most important step. Individualised management per EAU 2024 guidelines.
References
- EAU Guidelines on Non-muscle-invasive Bladder Cancer 2024 — uroweb.org
- EAU Guidelines on Muscle-invasive Bladder Cancer 2024 — uroweb.org
- Babjuk M et al. EAU Guidelines on Non-muscle-invasive Bladder Cancer. Eur Urol. 2022.
- Sylvester RJ et al. BCG induction with vs without maintenance for NMIBC. J Clin Oncol. 2016.
Medical review
Dr. Marinos Vasilas, Urologist – Andrologist
Dr. Vasilas performs TURBT with emphasis on complete resection, correct staging, and systematic surveillance per EAU 2024 protocols, aiming for the best oncological outcome for each patient.
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