Transurethral Resection of Bladder Tumor (TURBT)
When a tumor is found in the bladder via cystoscopy, it will be typically removed or at least biopsied via a Trans-Urethral Resection of Bladder Tumor (TURBT). This procedure utilizes the same instrumentation as a trans-urethral resection of the prostate, a bipolar resectoscope, which is a scope inserted into the urethra to the bladder. The scope is connected to video, allowing one to see the inside of the bladder on a video monitor. The tumor is found, and is shaved off of the bladder wall with several passes of the resectoscope. A proper resection will remove the tumor, but will also shave extensively enough to provide deeper layers of the bladder called the lamina propria and muscle layer to determine if the bladder cancer is invasive or not as well as the depth of invasion.
A: High grade bladder cancer. B: Same area of bladder after complete resection.
Most TURBT procedures are done in an outpatient surgical center setting, though at times it will be performed in a hospital for medical reasons or if the tumor is large enough to raise the risk of post-operative bleeding or bladder perforation which is an uncommon complication of TURBT. When done in the hospital it is typical to stay overnight. Almost all patients will go home with a catheter that will remain 2-4 days based on the depth and size of resection. Antibiotics will be necessary throughout this time. The catheterization allows for bladder wall healing. During this time, blood in the urine is very common and should cause no concern as long as the catheter is functioning. Other common complaints are bladder spasms and bladder pain referred to the tip of the penis in a man. These symptoms usually resolve once the catheter is removed.
Dr. Engel will have the patient remove the catheter at home 8-10 hours before coming into the office to review the pathology report. Dr. Losee will remove the catheter himself in the office. The pathology report, specifically the grade and depth of invasion of the tumor, will dictate future management. The main risk of a TURBT is bladder perforation, bleeding and infection.