TURBT

Transurethral resection of bladder tumor (TURBT) is a diagnostic and therapeutic procedure for bladder neoplasms. Performed endoscopically through the urethra, it allows direct visualization, tissue sampling, and removal of tumors to aid staging and local control. The pathologic specimen is used to determine tumor type, grade, and depth of invasion, which guides treatment.

Indications include suspected bladder cancer presenting with hematuria, known bladder tumors requiring resection, and staging of non-muscle-invasive disease.

Technique: Under anesthesia, a resectoscope is inserted; the tumor is resected with an electric loop and fragments removed. Depth of resection aims to include detrusor muscle. Most modern TURBT uses bipolar energy with saline irrigation; en bloc resection is possible for select tumors. A catheter for irrigation commonly remains postoperatively to maintain patency and hemostasis.

Pathology and staging: Specimens are assessed for tumor type, grade, and stage (Ta, T1, carcinoma in situ). The presence of detrusor muscle in the specimen is important for accurate staging; if muscle is absent, a repeat resection may be required.

Postoperative care and adjuvant therapy: Intravesical therapy with agents such as mitomycin C or Bacillus Calmette-Guérin (BCG) may be used after TURBT, depending on risk. Follow-up typically includes scheduled cystoscopy and urine cytology at intervals to monitor for recurrence.

Risks and prognosis: Complications include bleeding, infection, bladder perforation, and obturator reflex. Recurrence is common in bladder cancer, making careful surveillance essential. Overall prognosis depends on tumor stage, grade, and response to adjuvant therapy.