Trans urethral removal of bladder tumour (TURBT)

A trans urethral resection of bladder tumour (TURBT) is usually the first treatment you have for non muscle invasive bladder cancer.

Your surgeon removes the ​tumour​ in your ​bladder​ through the ​urethra​ . The urethra is the tube that carries urine from the bladder to the outside of your body.

The surgeon puts a thin rigid tube called a cystoscope into your urethra. The cystoscope has optic fibres inside it, a light, camera and eyepiece at one end. The surgeon can look through the eyepiece or see images on a TV screen.

The surgeon passes small instruments down the cystoscope to cut any tumours out of your bladder lining.

When you might have a TURBT

TURBT is the main treatment for non muscle invasive bladder cancer. You usually have this operation as your first treatment.

TURBT can also diagnose bladder cancer and find out whether the cancer has spread into the muscle layer of the bladder wall. The surgeon removes the tumour (or tumours). They send the tissue they remove to the laboratory. This tells them:

• how far the cancer has grown through the bladder wall (the stage)

• how abnormal the cancer cells look under the microscope (the grade)

You sometimes have a second TURBT operation within 6 weeks of the first. You usually have this if you have a high risk non muscle invasive bladder cancer. This is to make sure the surgeon has removed all the cancer. And to double check how far your cancer has grown.

What happens

You usually have this at the hospital in the day surgery unit. You might go home on the same day of your operation. But sometimes you have to stay in overnight or for a couple of days.

You usually have it under ​general anaesthetic​ , which means you are asleep. In some hospitals, you may have a ​spinal anaesthetic​ instead of a general anaesthetic. This is an injection into your spine (epidural) so you can’t feel anything from below your waist.

This treatment takes between 15 to 90 minutes. 

Before the operation

A nurse usually sees you in pre-assessment clinic a week or two before surgery.

They’ll take some measurements (weight, temperature, heart and breathing rate, oxygen levels and your blood pressure).

You might have a ​blood test​ , ​chest x-ray​ and ​ECG​ . This is normal for anyone having a general anaesthetic.

The nurse gives you instructions about the operation and what to bring on the day. It’s a good idea to bring an overnight bag. They’ll also tell you when to stop eating or drinking.

For a general anaesthetic, you usually have to stop eating at least 6 hours beforehand. And you can drink sips of water up to 2 hours before.  

When you arrive

On the day of your operation you’ll see the surgeon who will explain the procedure and ask you to sign a consent form. This is a good time to ask any questions. You’ll also meet your anaesthetist who will get you to sleep and look after you while you’re asleep .

Your nurse gives you a hospital gown to change into and you remove all your clothing. Then the nurse and porter take you to the anaesthetic room on a theatre trolley.

You usually have a small tube put into your vein (​cannula​ ) before you have the anaesthetic. This is so they can give you medicines directly into your vein. Most hospitals also give you an injection of ​antibiotics​ before the procedure.

The operation

Once you are asleep or the spinal anaesthetic is working your surgeon passes the cystoscope into your urethra.

They use the cystoscope to look at the inside of your bladder. They also pass small instruments down the cystoscope. They use these instruments to remove any tumours. They then use a probe to seal (cauterise) the area to stop any bleeding. 

Cystoscopy for a man

Cystoscopy for a woman

Watch this 2 minute video to find out how you have a TURBT.

Looking for bladder tumours during surgery

It is important that the surgeon finds and removes all the areas of cancer during your TURBT operation. They might use different methods to help them find all the tumours. These methods are not available in all centres. Your surgeon will explain what method they will use.

Narrow band imaging

Your surgeon uses different colour lights (blue and green) to get a better look and understanding of your bladder. These lights can reach deeper tissue layers in the bladder and can help show up abnormal areas. 

Photodynamic diagnosis (PDD)

Your surgeon may put a dye into your bladder an hour before you have your TURBT. The dye is sensitive to light. During the surgery they shine a blue light on the bladder lining. This is called photodynamic diagnosis (PDD). It can help to show up areas of cancer more clearly.

Chemotherapy into your bladder

You usually have a single dose of ​chemotherapy​ into the bladder at the end of your operation. Or you may have it when you return to the ward. You have it within 6 hours of having the operation.

This is to help stop the bladder cancer from coming back and get rid of any cancer cells that may have been left behind.

Read more about having chemotherapy into the bladder

Possible risks

A TURBT is a safe procedure. Your nurse will tell you who to contact if you have any problems after your TURBT. Your doctors will make sure the benefits of having a TURBT outweigh any possible risks.

Some possible risks include:

Bleeding 

You should contact the hospital immediately if:

• the bleeding is getting worse

• there are blood clots in your urine

• you have severe pain when passing urine

• you can’t pass urine and have severe pain

Infection

There is a risk of infection. Symptoms can include:

• going to the toilet more often

• burning and stinging when passing urine

• high temperature

• feeling hot and cold or shivery

• cloudy or offensive smelling urine

• generally feeling unwell

Contact your doctor as you might need antibiotics to treat an infection.

Damage or injury to the bladder

Rarely, there can be a small tear (perforation) of the bladder or it may be injured. It’s likely this will settle with a catheter for a few days to rest the bladder. Very rarely you may need surgery to help fix this problem. 

Bruising and swelling

You might get a small bruise around the area where they put the needle in for the cannula.

There's is a risk that the anaesthetic or antibiotics will leak outside the vein. This can cause swelling and pain in your arm but it's rare.

Do I need further treatment?

This depends on whether you have low risk, intermediate risk or high risk non muscle invasive bladder cancer. 

If your cancer is low risk, you might not need any further treatment. You will have regular cystoscopies.

You might need to have further treatment if your cancer is intermediate or high risk. 

Read more about treatment options for non muscle invasive bladder cancer