What is a TURBT Procedure for Bladder Cancer?

"If such an abnormal appearance in the bladder is noted," Dr. Balar explains, "then ultimately, the surgeon, the urologist, will take the patient to the operating room to perform what is called a TURBT, or a transurethral resection of a bladder tumor."

Dr. Arjun Balar explains how to manage a bladder cancer diagnosis

What Happens During a TURBT Procedure?

Once your doctor has determined that a TURBT procedure is right for you, a rigid cystoscope is inserted through the urethra and into the bladder. This instrument is designed to perform a more thorough evaluation of the bladder, Dr. Balar explains.

"And this is obviously done under general anesthesia in the operating room," he adds.

Once you're under anesthesia and the surgeon inserts the cystoscope through the urethra, they will do a scraping inside your bladder. "That is to assess where the bladder cancer is," Dr. Balar says, "and do an aggressive scraping to get a real sense of if the cancer is invasive, how invasive is (the cancer)? What we want to know there is really the stage."

If your doctor is removing a tumor, this can also be done via a TURBT procedure. Tumors in the bladder are removed through the urethra without having to cut through the abdominal or pelvic skin. So, there is good news: this procedure won't leave a scar.

What is the Goal of a TURBT Procedure?

There are four main goals of a TURBT procedure, as outlined by the National Comprehensive Cancer Network.

• To confirm a bladder cancer diagnosis
• To determine how extensive the cancer is inside the bladder (if any)
• To remove all of the visible tumor
• To take a small sample of the muscle layer of the bladder wall to see if the tumor has invaded into the muscle

TURBT for Stage 0 & 1 Bladder Cancer

Stage 0 bladder cancer is diagnosed with a TURBT procedure. Low-grade stage Ta tumors are sometimes treated with intravesical (local) chemotherapy.  (When given after a TURBT procedure, intravesical chemo is shown to lower the risk of recurrence, according to NCCN. The one-time dose is to be given within 24 hours of surgery.)

High-grade stage Ta tumors and Tis (CIS) tumors are treated after diagnosis with a type of immunotherapy called BCG. Intravesical BCG therapy, or bacillus Calmette-Guérin therapy, uses a liquid solution placed directly into your bladder. The liquid solution has been found to jumpstart your immune system and cause it to attack cancer cells inside your bladder.

However, in stage 1 (T1) bladder cancer, the tumor has grown slightly deeper into the bladder wall. Nearly all of these tumors are high-grade (fast-growing) and likely to come back after treatment. Because of this, a second TURBT procedure may be required four to six weeks after the initial TURBT. (Treatment for stage 1 bladder cancer is dependent on whether a second TURBT is done and if the test found cancer.)

If a second TURBT procedure is performed, further treatment for bladder cancer will depend on whether cancer cells are found and how deep they are in the bladder wall.

If during the second TURBT cancer is found, depending on the stage of the tumor, there are three options available: surveillance by cystoscopy only, intravesical BCG therapy or radical cystectomy, which is surgery. (A radical cystectomy is a procedure in which the bladder is removed from the body.)

However, if no cancer is found during the second TURBT after diagnosis of stage 1 (T1) bladder cancer, available options mainly include cystoscopic surveillance or intravesical BCG therapy.

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