What is TURBT (Transurethral Resection of Bladder Tumor)?

Transurethral Resection of Bladder Tumor (TURBT)

TURBT is a surgical procedure performed to diagnose, stage, and treat bladder tumors by resecting visible tumors and obtaining tissue specimens for pathological examination, with the goal of complete tumor removal and accurate staging to guide further treatment decisions.

Purpose and Indications

TURBT serves multiple critical functions in bladder cancer management:

• Diagnostic: Confirms the presence of bladder cancer and determines histology
• Staging: Assesses depth of invasion, particularly whether muscle invasion has occurred
• Therapeutic: Removes visible tumor tissue, potentially curative for non-muscle invasive disease
• Risk stratification: Helps determine risk of recurrence and progression

Procedural Technique

The standard TURBT procedure involves:

1. Patient positioning: Lithotomy position under anesthesia
2. Bimanual examination: Performed to assess tumor mobility and local extent 1
3. Cystoscopic visualization: Identification of all visible tumors
4. Resection technique:
   • Systematic removal of tumor using electrocautery loop
   • Resection proceeds from tumor to deeper layers including muscle
   • Specimens are collected for pathological examination
   • Adequate muscle sampling is essential for accurate staging 1, 2
5. Hemostasis: Achieved through cauterization of the resection area 3

Critical Components for Quality TURBT

• Complete resection: All visible tumors must be removed 2
• Muscle sampling: Detrusor muscle must be included in the specimen for proper staging 1, 2
• Margin assessment: Sampling of apparently normal tissue surrounding the tumor (approximately 1 cm) 4
• Documentation: Size, location, number, and appearance of tumors

Enhanced Techniques

Several advancements have improved TURBT outcomes:

• Blue light cystoscopy: Improves tumor detection, particularly for CIS and multifocal disease 1, 2
• Narrow band imaging: Enhances visualization of suspicious areas 2
• En bloc resection: Removes tumor in one piece rather than piecemeal, improving specimen quality 2, 5
• Bipolar resection: May reduce complications compared to monopolar techniques 5

Repeat TURBT Indications

A second TURBT (within 2-6 weeks) is recommended for:

• High-grade T1 tumors
• Incomplete initial resection
• Absence of muscle in the specimen for high-grade disease
• Large or multifocal lesions 1

Potential Complications

• Bleeding: May require transfusion or intervention for hemostasis
• Bladder perforation: Can be extraperitoneal or intraperitoneal
• Urinary tract infection: Requires appropriate antibiotic therapy
• Obturator nerve reflex: Can cause leg adduction and potential bladder perforation 3

Post-TURBT Management

• Immediate postoperative intravesical chemotherapy: Should be administered within 24 hours if non-muscle invasive disease and no bladder perforation 1
• Pathology review: Determines further management based on stage, grade, and presence of variant histology
• Risk stratification: Guides subsequent treatment decisions (observation, intravesical therapy, radical cystectomy)

Common Pitfalls to Avoid

• Inadequate muscle sampling leading to understaging
• Incomplete resection resulting in early recurrence
• Failure to identify carcinoma in situ
• Missing variant histologies that may alter treatment approach

TURBT remains the gold standard for diagnosis and initial treatment of bladder cancer, with quality of resection directly impacting patient outcomes including recurrence rates, progression, and need for more invasive interventions 2, 6.