TURB Surgery: Transurethral Resection of Bladder Tumor

What Is TURB Surgery and Why Is It Performed?

TURB (Transurethral Resection of Bladder Tumor) is a minimally invasive surgical procedure used to diagnose and treat bladder tumors by removing them through the urethra without external incisions. It is the gold standard treatment for non-muscle invasive bladder cancer and is used both for therapeutic removal and to obtain tissue samples for staging.

Transurethral resection of bladder tumor, commonly known as TURB or TURBT, is a specialized endoscopic procedure that allows urologists to visualize, biopsy, and remove abnormal growths from the bladder wall. The procedure has been refined over decades and remains the primary method for managing bladder tumors that have not invaded the muscle layer of the bladder wall. Understanding why this procedure is recommended can help patients feel more prepared and confident about their treatment.

The bladder is a hollow, muscular organ that stores urine before it is expelled from the body. When abnormal cells begin to grow on the inner lining of the bladder, they can form tumors that may be benign (non-cancerous) or malignant (cancerous). Bladder cancer is one of the most common cancers worldwide, with approximately 80% of cases being non-muscle invasive at the time of diagnosis. For these patients, TURB offers an effective treatment that preserves the bladder while removing the cancerous tissue.

The procedure serves multiple important purposes in the management of bladder conditions. First, it provides definitive diagnosis by obtaining tissue samples that pathologists can examine under a microscope to determine whether cells are cancerous and, if so, what type and grade of cancer is present. Second, it can completely remove tumors that are confined to the superficial layers of the bladder, potentially curing the disease in some cases. Third, it helps stage the cancer by determining how deeply the tumor has grown into the bladder wall, which is crucial information for planning further treatment.

Who Needs TURB Surgery?

TURB is typically recommended for patients who have abnormal findings on imaging studies such as CT scans or ultrasounds, those who have experienced symptoms such as blood in the urine (hematuria), or individuals with suspicious findings during cystoscopy (a diagnostic procedure where a camera is inserted into the bladder). The most common indication is the presence of bladder tumors that appear to be superficial or non-muscle invasive based on imaging.

Patients with a history of bladder cancer who are undergoing surveillance may also need TURB if new tumors are detected. Bladder cancer has a relatively high recurrence rate, making regular monitoring and repeat procedures an important part of long-term management. Your urologist will discuss whether TURB is appropriate for your specific situation based on your medical history, imaging findings, and overall health status.

TURB vs. Other Treatment Options

While TURB is the standard first-line treatment for non-muscle invasive bladder tumors, other treatment options exist depending on the specific characteristics of the tumor and the patient's overall condition. For very small, low-grade tumors, some centers may offer office-based fulguration (burning) of tumors, though this approach does not provide tissue for pathological analysis. For more advanced tumors that have invaded the muscle layer, radical cystectomy (surgical removal of the entire bladder) or radiation therapy may be recommended instead of or in addition to TURB.

How Should You Prepare for TURB Surgery?

Preparation for TURB surgery includes stopping blood-thinning medications one week before, quitting smoking and alcohol 2-4 weeks prior, washing with antibacterial soap the night before or morning of surgery, and fasting from midnight. Inform your doctor about all medications you take and arrange transportation home.

Proper preparation for TURB surgery is essential to minimize the risk of complications and ensure the best possible outcome. The preparation process begins several weeks before the scheduled surgery date and involves several important steps that you should follow carefully. Your healthcare team will provide specific instructions tailored to your individual situation, but the following guidelines apply to most patients undergoing this procedure.

The weeks leading up to surgery provide an important opportunity to optimize your health and reduce surgical risks. Lifestyle modifications during this time can significantly impact both the safety of the procedure and the speed of your recovery. Taking these preparation steps seriously demonstrates your commitment to achieving the best possible outcome and helps your surgical team provide you with optimal care.

Medications to Stop Before Surgery

Blood-thinning medications increase the risk of bleeding during and after surgery. You will need to stop taking certain medications approximately one week before your procedure, unless your doctor advises otherwise. These include:

• Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, naproxen, aspirin, and similar medications
• Anticoagulants: Warfarin, heparin, and newer anticoagulants (your doctor will provide specific guidance)
• Antiplatelet medications: Clopidogrel and similar drugs
• Herbal supplements: Ginkgo biloba, garlic supplements, fish oil, and vitamin E in high doses

If you need pain relief during this period, paracetamol (acetaminophen) is generally safe to use. However, always confirm with your healthcare provider before taking any medication in the week before surgery. If you take blood thinners for a heart condition or other serious medical condition, do not stop them without first discussing this with both your urologist and the doctor who prescribed them.

Lifestyle Changes Before Surgery

Smoking and alcohol consumption both increase surgical risks and can slow recovery. If you smoke, stopping at least two to four weeks before surgery significantly reduces the risk of anesthesia complications, wound healing problems, and postoperative infections. The benefits of quitting begin almost immediately, with oxygen levels in your blood improving within hours and continuing to improve over the following weeks.

Alcohol can interact with anesthesia medications and increase bleeding risk. Stopping alcohol consumption at least two weeks before surgery is recommended. If you drink heavily and are concerned about withdrawal symptoms, discuss this with your doctor, as medical support may be available to help you stop safely.

The Day Before and Morning of Surgery

Your healthcare team will provide you with a special antibacterial soap to use the night before or the morning of your surgery. This soap helps reduce the bacteria on your skin and decreases the risk of infection. Follow the instructions provided carefully, making sure to wash your entire body, including the genital area.

You will need to fast before surgery, which means not eating or drinking anything from midnight the night before your procedure (or as otherwise instructed). This is important because having food or liquid in your stomach during anesthesia can be dangerous. If you accidentally eat or drink something, inform your surgical team immediately.

How Is TURB Surgery Performed?

During TURB surgery, the surgeon inserts a cystoscope through the urethra into the bladder while you are under general or spinal anesthesia. Using specialized instruments passed through the cystoscope, the surgeon visualizes and removes the tumor tissue, which is then sent for pathological analysis. The procedure typically takes 30 minutes to one hour.

Understanding what happens during TURB surgery can help alleviate anxiety and prepare you mentally for the procedure. The operation takes place in an operating room with specialized equipment and a trained surgical team. Modern TURB techniques have been refined to maximize tumor removal while minimizing damage to healthy tissue and reducing the risk of complications.

The surgical team typically includes a urologist who performs the procedure, an anesthesiologist who manages your comfort and vital signs, surgical nurses, and other support staff. Before the procedure begins, the team will verify your identity, confirm the planned procedure, and review any relevant medical information. This safety checklist is standard practice and helps ensure that everything proceeds correctly.

Anesthesia Options

TURB surgery can be performed under either general anesthesia (where you are completely asleep) or spinal anesthesia (where only the lower part of your body is numbed). The choice of anesthesia depends on several factors, including the expected duration of the surgery, your overall health, and the preferences of you and your anesthesiologist.

General anesthesia involves medications that put you into a deep sleep for the duration of the procedure. You will not be aware of anything happening and will wake up after the surgery is complete. This option is often preferred for longer or more complex procedures. Spinal anesthesia involves an injection in your lower back that numbs your body from the waist down. You remain awake but cannot feel any pain in the surgical area. Some patients prefer this option because recovery from spinal anesthesia is typically faster.

The Surgical Technique

Once anesthesia has taken effect, you will be positioned lying on your back with your legs slightly elevated. The surgeon begins by inserting a cystoscope, a thin tube with a camera and light at its end, through your urethra and into your bladder. The bladder is then filled with sterile fluid to expand it and provide better visualization of the bladder wall.

Using the camera, the surgeon carefully examines the entire bladder surface, noting the location, size, and appearance of any tumors or abnormal areas. Various instruments can be passed through the cystoscope to perform different tasks. The most commonly used is a wire loop that can cut tissue while simultaneously cauterizing (sealing) blood vessels to minimize bleeding. This technique is called electrocautery resection.

The surgeon systematically removes the tumor tissue, working from the surface down into the bladder wall. The depth of resection depends on the type and extent of the tumor. For cancerous tumors, it is important to remove tissue deep enough to include some of the muscle layer, as this provides important staging information. All removed tissue is collected and sent to the pathology laboratory for analysis.

After the tumor has been removed, the surgeon carefully inspects the resection site and the rest of the bladder to ensure complete tumor removal and to check for any additional abnormal areas. If any bleeding points are identified, they are cauterized. The procedure typically takes between 30 minutes and one hour, depending on the number and size of tumors.

What Happens to the Removed Tissue?

The tissue removed during TURB surgery is preserved and sent to a pathology laboratory where it is processed, stained, and examined under a microscope by a pathologist. This analysis provides crucial information including whether the tissue is cancerous, the type of cancer cells present, the grade (how abnormal the cells appear), and whether cancer has invaded the muscle layer of the bladder wall.

These pathology results typically take two to three weeks to complete and are essential for determining whether additional treatment is needed and what that treatment should be. Your urologist will schedule a follow-up appointment to discuss the results with you and explain the recommended next steps.

What Should You Expect During Recovery?

After TURB surgery, you will have a urinary catheter for 1-2 days. Common symptoms include burning with urination, urgency, and blood-tinged urine for several days to weeks. Most patients go home the same day or next day. Full bladder healing takes 2-3 weeks, during which heavy lifting, strenuous exercise, and sexual activity should be avoided.

Recovery from TURB surgery is generally quick compared to more invasive surgical procedures, but it still requires patience and adherence to your doctor's instructions. Understanding what to expect during the recovery period can help you prepare and know when symptoms are normal versus when you should seek medical attention.

The immediate post-operative period begins in the recovery room, where you will be monitored as the anesthesia wears off. Nursing staff will check your vital signs, pain levels, and urinary output. Most patients feel drowsy and may have some discomfort, but severe pain is unusual. If you received spinal anesthesia, you will need to remain lying flat for a few hours and will gradually regain sensation and movement in your legs.

The Urinary Catheter

After surgery, you will have a urinary catheter in place. This is a thin, flexible tube that drains urine from your bladder into a collection bag. The catheter serves several purposes: it allows your bladder to rest and heal, it enables the surgical team to monitor your urine output, and it helps flush out any blood or clots from the bladder.

In the hours following surgery, it is common for the catheter to drain blood-tinged or pink urine. This is normal and expected. If blood clots form in the catheter, the nursing staff may need to flush it with sterile saline solution to keep it clear. This flushing can cause a sensation of bladder fullness or urgency, which is temporary.

The catheter is typically removed on the first or second morning after surgery, once the urine has cleared sufficiently. Some patients may need to keep the catheter for longer, particularly if there was significant bleeding or if they have difficulty urinating once it is removed. If you are discharged with a catheter still in place, your healthcare team will teach you how to care for it at home.

Common Symptoms After Surgery

Once the catheter is removed, you may experience several symptoms as your bladder heals. These are common and usually improve over the following days to weeks:

• Burning or stinging during urination: This is one of the most common symptoms and results from irritation of the urethra and bladder lining. It typically improves within a few days.
• Urgency and frequency: You may feel the need to urinate more often or feel a strong urge that is difficult to delay. This occurs because the bladder is irritated and temporarily more sensitive.
• Blood in the urine: Seeing pink, red, or even tea-colored urine is normal in the first few weeks. The amount of blood typically decreases over time.
• Mild urinary leakage: Some patients experience small amounts of leakage, especially when they feel a strong urge. This usually resolves as the bladder heals.

Drinking plenty of fluids (approximately two liters per day) helps flush the bladder and can reduce symptoms. Water is ideal, though other clear fluids are also acceptable. Avoid alcohol and caffeine initially, as these can irritate the bladder.

Activity Restrictions During Recovery

The wound inside your bladder takes approximately two to three weeks to heal completely. During this time, certain activities can increase the risk of bleeding or other complications. You should avoid:

• Heavy lifting: Avoid lifting anything heavier than about 10 pounds (4-5 kg)
• Strenuous exercise: No running, cycling, swimming, or vigorous physical activity
• Sexual intercourse: Wait until your doctor confirms it is safe, typically 2-3 weeks
• Straining during bowel movements: Eat a high-fiber diet and stay hydrated to prevent constipation

Light activity such as walking is encouraged and helps prevent blood clots. Start with short walks and gradually increase the duration as you feel comfortable. Listen to your body and rest when needed.

Returning to Work and Normal Activities

Most patients can return to light, sedentary work within one to two weeks after surgery. If your job involves physical labor or heavy lifting, you may need two to three weeks off work. Discuss your specific situation with your doctor, who can provide a medical certificate if needed.

Driving can typically be resumed once you are no longer taking pain medications and feel comfortable performing emergency maneuvers. For most patients, this is within a few days to a week after surgery. Check with your doctor and your insurance company if you are unsure.

What Are the Risks and Complications of TURB?

Common side effects of TURB include blood in urine, burning during urination, and urinary urgency. Rare but serious complications include urinary tract infection (1-5%), bladder perforation (1-5%), significant bleeding, and difficulty urinating. Most complications can be managed effectively with appropriate medical care. Contact your doctor if you experience heavy bleeding, fever, or inability to urinate.

Like any surgical procedure, TURB carries certain risks and the possibility of complications. However, it is important to understand that TURB is generally a safe procedure that has been performed for decades with excellent outcomes. Most patients experience only minor, temporary side effects that resolve on their own. Serious complications are uncommon but being aware of them helps you recognize warning signs that require medical attention.

The risk of complications varies depending on factors such as the size and location of the tumor, your overall health, and whether you have had previous bladder surgeries. Your urologist can discuss your individual risk profile with you before the procedure. Understanding both the benefits and risks helps you make an informed decision about your treatment.

Common Side Effects

The following effects are expected after TURB and are not considered complications:

• Hematuria (blood in urine): Almost all patients have some blood in their urine after surgery. This can last for several days to weeks and typically improves gradually.
• Dysuria (burning with urination): Very common due to irritation of the urethra and bladder. Usually resolves within a few days to a week.
• Urinary frequency and urgency: The bladder may be irritable after surgery, causing frequent urination or a sudden strong urge. This typically improves over several weeks.
• Mild abdominal discomfort: Some cramping or discomfort in the lower abdomen is normal and can be managed with over-the-counter pain relievers.

Potential Complications

While less common, the following complications can occur and may require additional treatment:

Bladder perforation occurs when the resection extends through the full thickness of the bladder wall. Small perforations often heal on their own with extended catheter drainage, while larger perforations may require surgical repair. The risk is higher when tumors are located on thin parts of the bladder wall or when extensive resection is needed. Surgeons take great care to minimize this risk by carefully controlling the depth of resection.

When to Seek Medical Attention

While most symptoms after TURB are normal and resolve on their own, certain warning signs require prompt medical evaluation. Contact your healthcare provider or seek emergency care if you experience:

• Heavy bleeding that does not improve or gets worse
• Large blood clots that block urination
• Inability to urinate despite feeling a full bladder
• Fever above 38°C (100.4°F)
• Severe abdominal pain that is not relieved by pain medication
• Feeling very unwell or confused

When Will You Get Results and What Happens Next?

Pathology results from TURB surgery typically take 2-3 weeks. You will have a follow-up appointment where your urologist will explain the findings and discuss whether additional treatment is needed. Treatment options depend on tumor grade and stage and may include surveillance, intravesical therapy, or further surgery.

One of the most anxiety-provoking aspects of TURB surgery is waiting for the pathology results. Understanding the timeline and what the results mean can help you feel more prepared for your follow-up appointment and any treatment decisions that need to be made.

After the tumor tissue is removed during surgery, it is placed in a preservative solution and sent to the pathology laboratory. There, it undergoes a series of processing steps including fixation, embedding, sectioning, and staining. A pathologist then examines the tissue under a microscope, often using special stains and techniques to characterize the cells. This meticulous process ensures accurate diagnosis but requires time to complete properly.

Understanding Your Pathology Report

The pathology report provides several key pieces of information that guide treatment decisions:

• Tumor type: The vast majority of bladder tumors are urothelial carcinomas (also called transitional cell carcinomas). Other types include squamous cell carcinoma, adenocarcinoma, and small cell carcinoma.
• Tumor grade: Grade describes how abnormal the cancer cells appear. Low-grade tumors look more like normal cells and tend to grow slowly. High-grade tumors look very abnormal and tend to be more aggressive.
• Tumor stage: Stage describes how deeply the tumor has grown into the bladder wall. Non-muscle invasive tumors (stages Ta, T1, Tis) are confined to the inner layers, while muscle-invasive tumors (stages T2 and above) have grown into the muscle layer.
• Presence of carcinoma in situ (CIS): This is a flat, high-grade tumor that has not invaded beyond the innermost layer of the bladder. It is associated with higher risk of progression.

Treatment Options Based on Results

The recommended treatment after TURB depends on the pathology results. Your urologist will discuss the specific recommendations for your situation, which may include:

For low-grade, non-muscle invasive tumors (Ta low-grade): These tumors have a good prognosis but can recur. Treatment typically involves regular surveillance with cystoscopy (camera examination of the bladder) every 3-6 months initially, then less frequently if no recurrence. A single dose of intravesical chemotherapy (medication instilled into the bladder) may be given immediately after surgery to reduce recurrence risk.

For high-grade non-muscle invasive tumors (Ta high-grade, T1, CIS): These tumors have a higher risk of recurrence and progression to muscle-invasive disease. Treatment usually includes a course of intravesical therapy, most commonly with BCG (Bacillus Calmette-Guérin, a type of immunotherapy) or intravesical chemotherapy. A repeat TURB (called "re-TURB") may be recommended 4-6 weeks after the initial surgery to ensure complete tumor removal.

For muscle-invasive tumors (T2 or higher): When cancer has grown into the muscle layer of the bladder, more aggressive treatment is typically needed. Options include radical cystectomy (surgical removal of the entire bladder), radiation therapy, or chemotherapy, often used in combination. These treatments are major undertakings with significant implications, and your urologist or oncologist will discuss the options thoroughly with you.

Long-Term Follow-Up

Bladder cancer has one of the highest recurrence rates of any cancer, which makes long-term surveillance essential. Even after successful treatment, regular follow-up appointments are necessary to detect any recurrence early when it is most treatable. The frequency and duration of follow-up depend on the initial tumor characteristics but typically include:

• Cystoscopy every 3-6 months for the first 2-3 years
• Annual cystoscopy thereafter, potentially lifelong
• Periodic urine tests and imaging studies as indicated

This long-term commitment to surveillance can be challenging, but it is crucial for your health. Finding a healthcare team you trust and establishing good communication with them helps make this ongoing monitoring more manageable.

How Can You Participate in Your Care?

Active participation in your care improves outcomes. Ask questions to understand your condition and treatment options, seek second opinions if desired, bring a support person to appointments, and don't hesitate to contact your healthcare team with concerns. You have the right to understand your treatment and to make informed decisions.

Being an active participant in your healthcare leads to better outcomes and greater satisfaction with your care. Modern medicine recognizes the importance of shared decision-making, where healthcare providers and patients work together to determine the best course of action based on medical evidence and patient preferences. Understanding your rights and responsibilities as a patient empowers you to get the best possible care.

The diagnosis of a bladder tumor and the need for surgery can be overwhelming. Many patients feel anxious, confused, or unsure about what questions to ask. Remember that there are no stupid questions when it comes to your health. Your healthcare team is there to help you understand your condition and treatment options, and they would rather you ask questions than leave feeling uncertain.

Understanding Your Treatment

Before any procedure or treatment, you should receive clear information about:

• What the procedure involves and why it is recommended
• What the alternatives are, including the option of no treatment
• What the risks and benefits are
• What you can expect during recovery
• How long you may need to wait for the procedure

If you don't understand something, ask for it to be explained again in different terms. It can be helpful to bring a family member or friend to appointments to help remember information and provide support. Taking notes or asking if you can record the conversation (with permission) can also be useful.

Your Right to Make Decisions

After receiving information about your treatment options, you have the right to make decisions about your care. This includes the right to:

• Accept the recommended treatment
• Choose an alternative treatment option
• Decline treatment (with understanding of the consequences)
• Change your mind about a decision you have previously made
• Seek a second opinion from another specialist

Your consent is required before any procedure can be performed. This consent should be informed, meaning you understand what you are agreeing to. Never feel pressured to make a decision before you are ready, and don't hesitate to ask for time to think things over or discuss with family members.

If You Need Support

Dealing with a bladder tumor diagnosis and treatment can be emotionally challenging. Support is available through various channels:

• Healthcare team: Nurses, social workers, and patient navigators can provide information and emotional support
• Cancer support organizations: Many organizations offer support groups, educational resources, and practical assistance
• Mental health professionals: Counselors and psychologists experienced in working with cancer patients can help you cope
• Family and friends: Don't underestimate the value of support from loved ones

If you need an interpreter due to language barriers or have hearing difficulties, this service should be available through your healthcare facility. Ensuring clear communication is essential for your safety and understanding.