Transurethral resection of bladder tumour

Why are we operating?

The bladder tumour is shaved away from inside in strips, deep enough to stage it, gently enough not to perforate the organ being saved.

Indication: Bladder tumour found on cystoscopy or imaging, usually after painless visible haematuria.

The operation in 4 steps

1. 01Cystoscopy and mapping

   The urethra and whole bladder are inspected systematically and every tumour mapped before resection starts.

   Why: Urothelial cancer is a field disease: the mucosa that grew one tumour can grow others, so the survey is as important as the resection, and the map guides follow-up for years.

2. 02Resection in layers

   The diathermy loop shaves the tumour in strips down to and including detrusor muscle at its base, with specimens kept for staging.

   Why: The single most important pathology question is whether tumour invades muscle, and the answer only exists if muscle is in the pot. A resection without detrusor at the base is a biopsy that under-stages.

3. 03Haemostasis and the perforation check

   The base and edges are fulgurated dry; bladder filling is checked against the possibility of perforation, and the obturator reflex is remembered on the lateral walls.

   Why: Lateral-wall resection can pulse the obturator nerve and kick the leg into the loop; anticipating it (paralysis, technique) is how the deep perforation is avoided.

4. 04Catheter and intravesical dose

   An irrigating catheter is left; a single early dose of intravesical chemotherapy is considered where appropriate.

   Why: The single instilled dose kills the cells the resection scattered and measurably lowers recurrence. Everything after (surveillance, further instillations) hangs on what the pathologist reports.

Anatomy you need

The bladder and urethra as the resectoscope travels them; the ureteric orifices are the landmarks to spare.

What can go wrong

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.