Transurethral resection of bladder tumour (TURBT)

About TURBT

During a TURBT operation, your surgeon removes any abnormal growths (tumours) in your bladder. The tumour or tumours will be sent to a laboratory to find out if they are cancerous and if they have grown into the bladder wall.

TURBT is the first treatment you’re likely to have for what’s known as non-muscle invasive bladder cancer. This is when the tumour is on the lining of your bladder and hasn’t grown into the muscle layer below (non-muscle invasive). It’s also called early or superficial bladder cancer. 

About eight out of 10 people with have the non-muscle invasive type.

Straight after the procedure, you’re likely to have chemotherapy put into your bladder. This helps to reduce the chance of the cancer coming back.

Preparing for TURBT

You’ll meet the surgeon carrying out your procedure to discuss your care and find out what to expect. It may be different from what we describe here as it will be designed to meet your individual needs.

You’ll probably need to stay in hospital for one to three days, but this can vary depending on the size and nature of your tumour. It’s a good idea to arrange for someone to take care of any important tasks you would normally have to do, such as taking care of pets or any carers’ responsibilities.

Your surgeon will explain how to prepare for your procedure. If you smoke, you’ll be asked to stop because smoking increases your risk of a chest or wound infection after surgery. This can slow your recovery. Smoking is also one of the main causes of bladder cancer, so stopping now may help to stop the cancer from coming back.

You’ll be given either a  or a . If you have a general anaesthetic, you’ll be asleep throughout the operation. If you have a spinal anaesthetic, you’ll be awake but you’ll feel numb from the waist down.

Having an anaesthetic can make you sick so it's important that you don't eat anything for six hours before your operation. You may be able to drink water until two hours before your surgery but follow the instructions of your anaesthetist or doctor. If you have any questions, just ask.

At the hospital, your nurse will check your heart rate and blood pressure, and they may also test your urine.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine as well as or instead of wearing compression stockings.

Your nurse or surgeon will explain what will happen after your operation, including any pain you might have. If you’re unsure about anything, ask. No question is too small. It’s important that you feel fully informed so you’re in a position to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.

Alternatives to TURBT

TURBT is the main treatment for non-muscle invasive bladder cancer. After TURBT, you may have additional tests such as a CT scan or MRI scan which can help find out whether cancer has spread. Your doctor will use this information in deciding any further treatment.

If the cancer has grown into the muscle of your bladder wall or has spread outside your bladder, your doctor may suggest other treatments. These could include an operation to remove all or part of your bladder, radiotherapy and chemotherapy. Talk to your doctor for more information.

Procedure of TURBT

Depending on how many tumours you have and how big they are, the operation can take between 15 minutes and one and a half hours. Before the operation starts, you’ll probably have antibiotics through a drip or injected straight into a vein.

Your surgeon will put a thin, tube-like telescope called a cystoscope into your urethra (the tube where urine comes out of your body) and up into your bladder. A camera lens at the end of the cystoscope sends pictures from the inside of your bladder to a monitor, where your surgeon can see them.

Your surgeon will then pass surgical instruments through the cystoscope to remove the tumour. These instruments use heat from electricity or a laser to remove the tumours. The heat also stops any bleeding from where the tumours are removed.

Your surgeon will also remove some deeper tissue to check if the cancer has spread into the bladder wall. These tissue samples are sent to the laboratory for testing.

At the end of the operation, your surgeon will remove the cystoscope and put a thin, flexible tube into your urethra. This is called a catheter and is connected to a bag to collect your pee. 

Your surgeon will put chemotherapy into your bladder through the catheter. This goes in straight after the operation and stays in your bladder for an hour before it’s drained out. This is to help reduce the risk of the bladder tumours coming back. It doesn’t cause the usual side-effects of chemotherapy. There is more information in our section: Side-effects of TURBT.

Aftercare for TURBT

You’ll need to rest until your anaesthetic has worn off. There are medicines available to ease any pain or discomfort you may have.

You may need to keep wearing compression stockings until you’re up and about. Getting out of bed and moving around is a good idea, although you may not feel like it. It will help to stop later problems developing – such as blood clots in your legs or lungs.

After a general anaesthetic, you may find you’re not as coordinated as usual or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.

You might see some blood in your urine. This is normal after a TURBT. When you’re able to, make sure you drink plenty of fluids (around eight glasses or 2 litres each day). Your nurse may use your catheter to flush your bladder out with fluid after your operation. You may also have a bag of fluid attached to the catheter, so that it continuously runs into your bladder and then out to the drainage bag. This is called continuous irrigation and helps to stop blood clots forming.

Your nurse will take your catheter out before you go home. At first, you might find it uncomfortable to pass urine. You may have a burning feeling when you pee, and find you need to go urgently or more often. These symptoms usually get better in a few days but if they don’t, see your doctor.

Before you leave hospital, your nurse will give you a follow-up appointment to talk about the results from your surgery. You’ll need to arrange for someone to drive you home. And if you live alone, have a friend or relative stay with you for the first 24 hours or so. 

Recovery from TURBT

You may feel tired and washed out for a few days after your operation. If you need pain relief, you can take such as paracetamol. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor for advice.

How fast you recover varies from person to person, but generally the lining of the bladder will heal in about 10 days. You can usually get back to most normal activities by two weeks (but don’t do anything too strenuous). Ask your surgeon when you can go back to work.

You may have some bleeding for up to three weeks after your operation. However, if you have large blood clots and these stop you peeing, contact your surgeon straightaway, or go to your local accident and emergency department.

Up to one in 10 people develop a urine infection after TURBT, so it’s important to be aware of the symptoms. See your doctor if you:

• feel that you need to pee urgently and often or when you’ve just been
• have pain or discomfort when you’re peeing
• have smelly or cloudy pee
• have a temperature above 37.5 °C
• develop a constant lower abdominal (tummy) ache
• feel generally unwell – aching all over, feeling sick, tiredness and shivering or cold sweats

To make sure you fully recover and heal well at home:

• drink plenty of fluids – around eight glasses (2 litres) a day
• take any antibiotics you were given after your operation
• don’t drive until you feel comfortable doing so

Follow up after TURBT

Any further treatment you have after TURBT depends on the risk of the cancer coming back and if it has spread into the bladder wall. Your surgeon and healthcare team will discuss this and then meet with you to explain your options. They will talk you through the risks and benefits of further procedures and treatments. 

Further treatments may include: 

• regular cystoscopies to check that the cancer hasn’t come back (a cystoscopy uses a tube with a telescope that goes up into your urethra to look inside your bladder)
• another TURBT (within six weeks of the first one)
• a course of at least six more treatments of chemotherapy put into your bladder
• an immunotherapy treatment called BCG (Bacille Calmette-Guerin) put into your bladder
• surgery to remove your bladder
• radiotherapy or chemotherapy

Side-effects of TURBT

Side-effects are the unwanted but mostly temporary issues you may have after medical treatment. How bad the side-effects are, and how long they last can vary. After a TURBT, you may: 

• feel tired and washed out
• have pain and discomfort when going for a pee
• have blood in your pee
• develop a urine infection 

There is more information about infection, bleeding and what to look out for in our section: Recovery from TURBT.

Chemotherapy into the bladder usually causes few side-effects because it doesn’t get into your bloodstream. You may have a skin rash or itching for a short time.

Complications of TURBT

Complications are problems that can occur during or after treatment. The possible complications or risks of any operation include an unexpected reaction to the anaesthetic or developing a blood clot in your leg ().

Possible complications of TURBT are outlined here, with the most common complications listed first. We haven’t included the chances of these happening because they are different for every person. Speak to your own doctor for more information about complications and how they might affect you. And besure to tell your doctor immediately if you think you have any of the following after your operation.

• Urine infection – bacteria may get into your urinary tract either during the operation or afterwards when a catheter is put in. See our section on recovery for symptoms to watch out for.
• All of the cancer might not be removed or the cancer might come back. You’ll have regular check-ups after your TURBT and if there is any sign of cancer, you’ll be offered more treatment.
• Bleeding that doesn’t stop and blood clots – you may need an operation to stop the bleeding and remove blood clots. Large clots can stop you peeing. If you can’t pee, speak to your surgeon straightaway or go to accident and emergency.
• Small holes made in your bladder wall during the operation. This is called perforation. If this happens, your catheter might need to stay in for longer than usual. If the hole is large, you may need an operation to fix it.