What is the treatment for a bladder polyp (bladder growth)?

Treatment of Bladder Polyps

The primary treatment for bladder polyps is transurethral resection (TUR), which serves both diagnostic and therapeutic purposes, followed by risk-stratified management based on pathology results. 1

Initial Management

All bladder polyps require complete transurethral resection (TURBT) as the standard first-line treatment. 1 This procedure:

• Provides definitive tissue diagnosis to distinguish benign polyps from malignancy 2, 3
• Achieves complete removal in most cases 2, 4
• Must include both the tumor base and edges sent separately to pathology to ensure adequate staging 1
• Should document the presence of lamina propria and muscle in the specimen 1

Post-Resection Management Based on Pathology

For Benign Polyps (Fibroepithelial Polyps)

• Endoscopic resection alone is curative with excellent prognosis 2, 3
• No adjuvant therapy required 2, 4
• Follow-up cystoscopy at 3-6 months to confirm no recurrence 5
• Recurrence is rare after complete resection 2

For Low-Grade Ta Tumors

• Consider single immediate intravesical chemotherapy (mitomycin C) within 24 hours of resection, which reduces recurrence risk by 11% 1
• May follow with 6-week induction of intravesical chemotherapy for intermediate-risk features 1
• Cystoscopy at 3 months initially, then at increasing intervals 1

For High-Grade Ta Tumors

• Intravesical BCG is the preferred adjuvant treatment over chemotherapy 1
• Repeat TUR should be strongly considered if no muscle was present in initial specimen (49% understaging risk) 1
• Cystoscopy and urine cytology at 3-6 month intervals for first 2 years 1
• Upper tract imaging every 1-2 years 1

For Muscle-Invasive Disease (T2 or Higher)

• Radical cystectomy is standard treatment 1, 5
• Bladder-sparing approaches only in highly selected cases: solitary lesions <2 cm with minimal muscle invasion, no hydronephrosis, no carcinoma in situ 5

Important Caveats

A second-look TUR is critical in high-risk cases because residual disease is found in 27% of Ta tumors when muscle was present initially, and 49% are understaged when muscle was absent. 1

Avoid immediate intravesical chemotherapy if:

• TURBT was extensive 1
• Bladder perforation is suspected 1

Potential complications to monitor:

• Urethral stricture (occurred in 2 of 23 patients in one series, requiring repeated dilations) 2
• Mild perioperative hematuria 2
• Reduced bladder compliance during healing 5

Follow-Up Protocol

• Post-surgical monitoring for at least 3-6 months to ensure proper healing 5
• Cystoscopy intervals determined by risk stratification 1, 5
• Monitor for strictures, reduced bladder compliance, or impaired function during healing period 5