03 / Urology · endoscopic
Transurethral resection of bladder tumour
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.
Stage
1 / 4
Cystoscopy and mapping
The urethra and whole bladder are inspected systematically and every tumour mapped before resection starts.
Watch for: Missed second tumour, especially behind the bladder neck
Why are we operating?
TURBT resects bladder tumours from inside: a diathermy loop shaves the tumour off the bladder wall in strips, treating what it removes and staging what it samples, because the specimen's detrusor muscle answers the question that splits bladder cancer in two. Non-muscle-invasive disease begins surveillance; muscle-invasive disease begins a different, radical conversation.
Pulls toward surgery
Gives the team pause
Shared foundations
What the surgeon is thinking
Cystoscopy and mapping
Why does the operation start with a formal map?
Bladder cancer is a field disease: the whole urothelium was exposed to the same carcinogens, so the survey documents every lesion's site, size and character before any resection muddies the water with blood and debris. The map also writes the surveillance programme that follows for years.
Resection in layers
Why must detrusor muscle appear in the specimen?
Because staging is the operation's second product: the fork between non-muscle-invasive and muscle-invasive disease is the biggest decision in bladder cancer, and it cannot be taken without muscle under the tumour to examine. A TURBT without muscle in the pot is incomplete by definition and often repeated.
Haemostasis and the perforation check
What makes bladder haemostasis its own discipline?
The field is underwater and the wall is thin: each bleeding point is rolled and coagulated with the bladder at moderate filling, because a distended bladder stretches vessels shut only to reopen them at rest, and an overzealous coagulation burns deeper than it looks. Clear irrigation at the end is the exam passed.
Catheter and intravesical dose
Why does a single dose of intravesical chemotherapy follow the resection?
The resection liberates tumour cells into a raw-walled bladder: one dose of mitomycin within hours kills the floaters before they implant, and measurably reduces recurrence. It is prophylaxis against the operation's own mechanism, withheld only when perforation is suspected.
Decision points
The tumour sits on the lateral wall and the leg kicks with each cut (obturator reflex).
Pause and neutralise: paralysis, technique changes
The obturator nerve runs beside the lateral wall and diathermy triggers adduction: muscle relaxation with the anaesthetist, staccato cutting, or bipolar settings tame it.
Press on carefully
The named error: an unexpected kick with the loop buried in a thin wall is how lateral-wall perforations happen.
The obturator jerk is predictable from the tumour's address, so the countermeasure is arranged before the loop touches the wall: this is the operation's signature hazard and the classic viva question because it is the classic real event.
High-grade T1 disease on histology. What does the bladder get next?
Re-resection within weeks, then intravesical BCG
Understaging is common: the re-look confirms no muscle invasion, and BCG then treats the field disease.
Straight to surveillance
Inadequate for high-risk disease: the recurrence and progression rates say this tumour has not finished being staged.
TURBT is often the first move of a long campaign, not its conclusion: risk category writes the sequel (single-dose chemo, re-resection, BCG, or the radical conversation), and the surveillance cystoscopy relationship can last decades.
Leaving the OR
The handoff
- Procedure
- TURBT: 2 cm posterolateral tumour resected to muscle; map documented
- Specimen
- Tumour strips and separate deep muscle chips to histology
- Bladder
- Irrigation clear; single-dose mitomycin instilled; catheter on free drainage
- Watch for
- Clot retention (irrigation stopping), abdominal pain suggesting perforation, haematuria tier
A fictional educational patient, handed over the way real ones are.
The postoperative course
- Day 0Rosé urine clearing on the catheter; the mitomycin dwell completed and documented; pain that is more than bladder spasm gets examined, not sedated.
- Day 1Catheter out when clear for most; home with haematuria advice, since a secondary bleed around day 7-10 as the scar sloughs is a known caller.
- WeeksHistology decides the sequel: risk category, re-resection need, and the intravesical therapy conversation, all at the MDT.
- Long termSurveillance cystoscopy on a risk-stratified calendar: bladder cancer's defining feature is recurrence, and the map made at this operation is the baseline for every look that follows.
Watch it done
Bladder cancer treatment: TURBT
The society's explainer of resecting a bladder tumour through the resectoscope.
Source: European Association of Urology · Watch on YouTubeTURBT: transurethral resection of a bladder tumour
Endoscopic footage of the resection, narrated by the surgeon.
Source: Professor Mohamed H Khadra, urological surgeon · Watch on YouTube