TURBT for Bladder Tumours in Kuala Lumpur
Transurethral Resection of Bladder Tumour (TURBT)
TURBT for Bladder Tumours in Kuala Lumpur
Transurethral Resection of Bladder Tumour (TURBT)
A bladder tumour may be discovered during investigations for blood in the urine, urinary symptoms, or an abnormal finding on imaging.
When a tumour is identified inside the bladder, a procedure called Transurethral Resection of Bladder Tumour (TURBT) is commonly performed to remove the visible tumour and obtain tissue for examination.
TURBT plays a central role in both the diagnosis and initial treatment of bladder cancer. The tissue obtained allows the pathologist to determine the type, grade, and extent of the tumour, which helps guide further management.
What Is TURBT?
TURBT is an endoscopic surgical procedure performed through the urethra, the natural passage through which urine leaves the bladder.
A specialised instrument called a resectoscope is passed into the bladder. This allows the urologist to inspect the bladder lining, identify abnormal tissue, and remove the tumour using specialised surgical instruments.
No abdominal incision is required.
The removed tissue is sent for histopathological examination to establish the diagnosis and assess the tumour’s characteristics.
Unlike a simple bladder biopsy, TURBT aims to remove the visible tumour where technically feasible while obtaining tissue of sufficient quality and depth for accurate pathological assessment.
Why Is TURBT Necessary?
A bladder tumour seen on ultrasound, CT imaging, or cystoscopy cannot be reliably classified by appearance alone.
Although some tumours may look superficial, their actual depth of invasion can only be assessed through tissue examination.
TURBT helps answer three important clinical questions:
1. Is the tumour cancerous?
Not every abnormal bladder growth is malignant. Histopathological examination is needed to confirm the diagnosis and identify the tumour type.
2. How aggressive is the tumour?
Bladder cancers are classified according to their grade, which describes how abnormal the cancer cells appear under the microscope.
High-grade tumours generally carry a greater risk of recurrence and progression than low-grade tumours.
3. Has the tumour invaded the bladder muscle?
The bladder wall contains several layers, including the inner lining, connective tissue, and muscular wall.
Determining whether cancer has reached the bladder muscle is particularly important because treatment differs substantially between non-muscle-invasive and muscle-invasive bladder cancer.
An adequate TURBT specimen should include detrusor muscle when clinically indicated, allowing more reliable assessment of the depth of tumour invasion.
When Is TURBT Recommended?
TURBT is commonly recommended when a bladder tumour or suspicious lesion is identified during investigations.
Possible reasons for investigation include:
Visible blood in the urine, even when painless
Microscopic blood in the urine requiring further assessment
A bladder mass detected on ultrasound or CT imaging
A suspicious lesion identified during cystoscopy
A previously treated bladder tumour that has recurred
Some patients have no urinary symptoms, and the tumour is discovered incidentally during imaging for another condition.
The need for TURBT depends on the cystoscopy findings, imaging results, and overall clinical assessment.
How Is TURBT Performed?
TURBT is generally performed under general or spinal anaesthesia.
Step 1: Examination of the bladder
A resectoscope is introduced through the urethra into the bladder.
The urologist systematically examines the bladder lining to identify the tumour, assess its location and appearance, and look for additional suspicious areas.
Step 2: Removal of the tumour
The visible tumour is removed using an endoscopic resection instrument.
Depending on the size, location, and appearance of the tumour, removal may involve conventional resection or an en bloc technique in selected cases.
The aim is to remove the visible lesion safely while obtaining tissue suitable for pathological assessment.
Step 3: Assessment of the tumour base
The underlying tissue is assessed and sampled as appropriate to determine whether the tumour has invaded deeper layers of the bladder wall.
Care is taken to balance adequate tissue sampling with the risk of bladder injury.
Step 4: Control of bleeding
Bleeding points are controlled using endoscopic instruments.
A urinary catheter may be inserted after the procedure to drain the bladder and, when necessary, allow continuous bladder irrigation.
The duration of surgery varies according to the size, number, and location of the tumours.
What Happens After TURBT?
After the procedure, patients are monitored for bleeding, discomfort, and their ability to pass urine.
A urinary catheter may remain in place temporarily, particularly after a larger resection or when bladder irrigation is required.
Common temporary symptoms include:
Blood-stained urine
Mild burning or discomfort during urination
Increased urinary frequency or urgency
Bladder spasms, particularly when a catheter is present
These symptoms generally improve as the bladder heals.
Some patients may be discharged on the same day, while others require an overnight stay or longer observation, depending on the extent of surgery and their recovery.
Patients are usually advised to avoid heavy lifting and strenuous physical activity during the initial recovery period.
Seek urgent medical assessment if you develop fever, are unable to pass urine, experience significant bleeding or blood clots, or develop severe abdominal pain.
Understanding the TURBT Pathology Results
The pathology report is one of the most important outcomes of TURBT.
It determines whether the tumour is cancerous, how aggressive it appears, and whether it has invaded the bladder wall.
Non-Muscle-Invasive Bladder Cancer
Non-muscle-invasive bladder cancer (NMIBC) refers to tumours that have not invaded the detrusor muscle.
These include:
Ta — Non-invasive papillary tumour
The tumour grows from the bladder lining without invading the underlying connective tissue.
T1 — Invasion into the connective tissue
The tumour has invaded the lamina propria beneath the bladder lining but has not reached the detrusor muscle.
Tis — Carcinoma in situ (CIS)
A flat, high-grade cancer confined to the bladder lining. Although it has not invaded deeper tissue, it can behave aggressively and requires appropriate treatment.
Muscle-Invasive Bladder Cancer
T2 — Invasion into the bladder muscle
Cancer has invaded the detrusor muscle.
This finding changes the treatment approach substantially. Further staging investigations and assessment for definitive treatment are generally required.
Treatment may involve radical cystectomy, systemic therapy, radiotherapy, or a combination of approaches depending on the disease stage and patient factors.
Why the Presence of Muscle in the Specimen Matters
A pathology report may indicate whether detrusor muscle is present in the resected specimen.
For many bladder tumours, particularly those suspected to be high-grade or invasive, the presence of muscle helps the pathologist assess whether cancer has reached the muscular wall.
If muscle is absent from a specimen where it is required for staging, the possibility of understaging must be considered.
However, muscle sampling is not necessary in every situation, such as selected low-grade Ta tumours.
Is One TURBT Always Enough?
Not necessarily.
A second TURBT, sometimes called a repeat or re-staging TURBT, may be recommended when there is concern that tumour tissue remains or that the original procedure did not establish the stage adequately.
Situations in which repeat TURBT may be considered include:
T1 bladder cancer
Incomplete initial tumour resection
Selected high-grade tumours
Inadequate staging information from the first procedure
For T1 disease and other appropriate indications, repeat TURBT is generally performed within approximately 2–6 weeks of the initial procedure.
The purpose is to identify residual cancer, improve staging accuracy, and guide subsequent treatment.
A second procedure does not necessarily mean that the first surgery was unsuccessful. It may form part of the recommended management of higher-risk bladder cancer.
Will I Need Treatment After TURBT?
Further treatment depends on the pathology findings and the estimated risk of recurrence or progression.
Low-Risk Non-Muscle-Invasive Bladder Cancer
For patients with low-risk non-muscle-invasive bladder cancer, complete TURBT is usually the main treatment.
A single dose of intravesical chemotherapy, administered within 24 hours after surgery, is commonly recommended to reduce the risk of recurrence when appropriate.
This treatment is avoided when bladder perforation is suspected or significant bleeding requires continuous irrigation.
Regular surveillance cystoscopy remains necessary.
Intermediate-Risk Bladder Cancer
Additional treatment inside the bladder may be recommended to reduce recurrence.
This may involve a course of intravesical chemotherapy or BCG immunotherapy, depending on the tumour characteristics and risk assessment.
High-Risk Non-Muscle-Invasive Bladder Cancer
High-risk disease often requires further treatment after TURBT.
Intravesical BCG therapy is commonly used to reduce the risk of recurrence and progression in appropriately selected patients.
In patients with very-high-risk disease or certain high-risk features, early radical cystectomy may also be discussed.
Muscle-Invasive Bladder Cancer
When cancer has invaded the bladder muscle, TURBT alone is generally insufficient as definitive treatment.
Further staging and multidisciplinary treatment planning are required.
Options may include radical cystectomy with appropriate systemic treatment or bladder-preserving trimodality treatment in selected patients.
The choice depends on tumour stage, overall health, and treatment suitability.
Can Bladder Cancer Return After TURBT?
Yes. Bladder cancer can recur even after the visible tumour has been completely removed.
The likelihood of recurrence varies considerably according to:
Tumour grade and stage
Number and size of tumours
Previous history of bladder cancer
Presence of carcinoma in situ
Other pathological risk factors
This is why follow-up cystoscopy is an essential part of bladder cancer management.
For many patients with non-muscle-invasive bladder cancer, the first surveillance cystoscopy is performed approximately three months after TURBT.
The frequency and duration of subsequent follow-up depend on the individual risk category.
Some patients require long-term or lifelong surveillance.
What Are the Risks of TURBT?
TURBT is a routinely performed endoscopic urological procedure, but complications can occur.
Potential risks include:
Bleeding or blood clots in the bladder
Urinary tract infection
Temporary difficulty passing urine
Bladder perforation
Urethral injury or subsequent stricture
Need for additional surgery or treatment
Bladder perforation is uncommon but may require prolonged catheter drainage or, occasionally, surgical repair.
The risks depend partly on the size, location, and depth of the tumour, as well as the patient’s underlying medical conditions.
These factors are assessed before surgery.
Continuing Care After TURBT
Management following TURBT depends on the histopathology findings, the risk of recurrence or progression, and whether additional treatment is required.
Follow-up may involve surveillance cystoscopy, intravesical therapy, further surgery, or multidisciplinary assessment.
Dr Roger Anthony Idi, Consultant Urologist at Prince Court Medical Centre, Kuala Lumpur, provides assessment and management of bladder tumours, including TURBT and subsequent follow-up care.
Frequently Asked Questions
Is TURBT a major operation?
TURBT is an endoscopic surgical procedure performed through the urethra without an abdominal incision. It is generally less invasive than open bladder surgery, although the extent of surgery and associated risks depend on the tumour.
Is TURBT painful?
The procedure is performed under general or spinal anaesthesia. Patients may experience temporary burning during urination, bladder discomfort, or catheter-related symptoms afterwards.
How long does recovery take after TURBT?
Many patients return to light daily activities within several days, although complete healing can take longer. Recovery depends on the extent of resection, bleeding, and any complications. Strenuous activity may need to be avoided for a few weeks.
Does TURBT mean I have bladder cancer?
Not necessarily. TURBT is performed to remove and examine suspicious bladder tissue. Histopathological examination is required to confirm whether the lesion is malignant.
Can TURBT completely remove bladder cancer?
For many patients with non-muscle-invasive bladder cancer, TURBT can completely remove the visible tumour. However, additional intravesical treatment or surveillance may still be necessary because bladder cancer can recur.
For muscle-invasive disease, TURBT alone is generally not sufficient as definitive treatment.
Why do I need another TURBT if the tumour has already been removed?
Repeat TURBT may be recommended to check for residual cancer or improve staging accuracy, particularly in T1 disease or after incomplete resection. This helps guide subsequent treatment decisions.
Will I need BCG after TURBT?
Not every patient requires BCG. It is generally considered for certain intermediate-risk and high-risk non-muscle-invasive bladder cancers. The decision depends on the pathology results and risk classification.
How often will I need cystoscopy after TURBT?
The first follow-up cystoscopy is commonly scheduled at approximately three months. Subsequent surveillance depends on the risk of recurrence and progression. Higher-risk disease generally requires more frequent and longer-term monitoring.
Assessment and Treatment of Bladder Tumours
A bladder tumour requires appropriate evaluation to establish the diagnosis and determine whether further treatment is necessary.
TURBT provides important pathological information while allowing removal of visible tumour tissue in suitable cases.
For assessment of a suspected bladder tumour or discussion of TURBT in Kuala Lumpur, an appointment may be arranged with Dr Roger Anthony Idi at Prince Court Medical Centre.
Related Reading
1. Bladder Cancer: Symptoms, Diagnosis and Treatment
Understanding bladder cancer, its stages and available treatment options.
2. Intravesical BCG Treatment for Bladder Cancer
How BCG immunotherapy is used after TURBT to reduce the risk of recurrence and progression.
3. Blood in Urine (Haematuria): Causes and Investigation
Why visible or microscopic blood in the urine may require further evaluation.