TURBT Surgery: Transurethral Resection of Bladder Tumor

Transurethral resection of bladder tumour (TURBT) is a surgical procedure to diagnose and treat early-stage bladder malignancy. It is the primary treatment for non-muscle invasive bladder cancer (NMIBC). In this type, the cancer cells are only present in the inner lining of the bladder. 

The bladder is a hollow, spherical organ located in the lower part of the abdomen. It is held by ligaments attached to surrounding organs and the pelvic bones. The primary function of the bladder is to hold urine. It expands and contracts based on the volume of urine it contains. 

The bladder is divided into four parts: 

1. Dome (Apex): Located at the top front of the bladder, it points towards the abdominal wall

2. Base (Fundus): The bottom back of the bladder 

3. Body: Occupies the space between the dome and the base 

4. Neck: Situated at the base of the bladder, it is a narrow group of muscles that connects to the urethra 

The three layers of the bladder are as follows: 

1. Urothelium: The innermost layer that prevents urine from leaking into the body.

2. Lamina Propria (Submucosa): A layer of connective tissue that includes proteins for structural support, blood vessels, and nerves.

3. Muscularis Propria: The outermost layer of the bladder. It is made up of three layers of smooth muscle that relax and contract involuntarily. 

TURBT surgery offers therapeutic and diagnostic benefits essential for effective disease management. A doctor may recommend this procedure for the following reasons: 

1. Diagnosis of bladder cancer 

2. Removal of suspected tumours 

3. Staging of the cancer by sending samples to a pathologist 

4. Checking metastasis (spread) of cancer to the bladder wall

The bladder surgery is performed under general or spinal anaesthesia to ensure the comfort of the patient. The procedure takes 15 to 90 minutes and includes the following steps: 

1. The surgeon inserts a cystoscope (a specialised endoscopic instrument equipped with a camera and light) through the urethra. This allows them to view the inside of the bladder on a monitor.

2. Once the tumour is located, an instrument with a small wired loop (resectoscope) is passed through the cystoscope. It removes tumours from the bladder wall.

3. The surgeon applies heat to seal (cauterise) the tumour area and stop bleeding. 

4. The scope is removed, and a catheter is inserted if needed in cases of excessive bleeding. 

Doctors provide detailed instructions to prepare for the TURBT procedure. Adhering to these guidelines before and on the day of the procedure is crucial to ensure the success of the surgery. 

Before TURBT

Patients generally meet their healthcare team two weeks before the procedure for a pre-anaesthesia check-up. During this visit, they can also expect to discuss some other preparatory guidelines, including: 

On the Day of TURBT

On the day of the procedure, patients should arrange for someone to drive them home after surgery. Upon arrival at the hospital, they will be guided through the pre-operative process, which includes the following: 

It is common to experience pain and bleeding for a week or two after TURBT. Following the doctor’s instructions can help ease recovery in the hospital and at home. 

In Hospital Recovery 

After a TURBT procedure, most patients can return home on the same day. They will be moved to a recovery room where the anaesthesiologist will monitor their vitals, including breathing and blood pressure. If a catheter is placed during surgery, the nursing staff will remove it before the patient is discharged home.

At-home Recovery 

TURBT recovery time is generally six weeks. Patients can expect to resume normal activities like work within two weeks. During this period, it is important to follow these guidelines: 

1. Rest for a week to allow the bladder to heal. 

2. Take prescribed pain medications to manage discomfort. 

3. Drink lots of water to flush out the bladder and prevent a urine infection. 

4. Avoid strenuous activities and heavy lifting for about three weeks. 

Follow-up Appointment

The first follow-up appointment is scheduled two weeks after TURBT. During this visit, the doctor assesses the recovery process and checks for signs of complications like infection and excessive bleeding. They also discuss the results of the pathology report from the tissue that was removed during the procedure. 

A second TURBT may be performed four to six weeks after the first in case a complete tumour was not resected during the first procedure. It also reduces the risk of cancer metastasising outside the bladder. 

According to a study by Jamie S Pak et al., 2021, the 5-year overall survival rate after complete TURBT is 77%. The procedure offers various benefits that contribute to its importance in treating bladder cancer. These include: 

1. TURBT is conducted via the urethra, eliminating the need for external incisions. 

2. The minimally invasive nature reduces the risk of infection or injury to the bladder. 

3. It allows patients to keep their bladder by only removing the cancerous tissues. 

4. A shorter hospital stay enables individuals to return home on the same day. 

5. If necessary, TURBT can be performed multiple times to treat recurrent tumours.

Like any surgical procedure, bladder tumour resection can result in certain risks. According to Kim et al., 2020, TURBT complications can occur in 4%-6% of cases. Some major risks include: 

1. Adverse reactions from anaesthesia 

2. Excessive bleeding 

3. Urinary tract infections 

4. Bladder perforation 

Getting repeated TURBT can also increase the risk of long-term bladder side effects like frequent urination and incontinence. 

When to call a doctor? 

After TURBT, patients must monitor their health closely for any signs of complications. They should immediately contact their doctor if they experience the following symptoms:

1. Blood clots in the urine 

2. Inability to pass urine 

3. Fever above 101 F and chills 

4. Nausea and vomiting

Non-muscle invasive bladder cancers are generally small and do not involve the muscle layer of the bladder. When treated promptly, they cause fewer complications than other bladder malignancies. However, delaying the TURBT surgery can lead to the following complications: 

1. Delay can allow the tumour to grow larger or invade deeper bladder wall layers. 

2. As the tumour grows, there is an increased risk of cancer cells spreading to other body parts. 

3. It can lead to increased symptoms, such as fatigue, weight loss, difficulty urinating, or urinary tract infection.  

Cost of TURBT 

The price of TURBT in India can vary significantly depending on several factors. The cost starts from ₹ 60,000 and can reach up to ₹ 1,50,000. The average expense is ₹ 1,00,000. 

Note: The figures mentioned above are approximate. Please consult HexaHealth experts for up-to-date prices. 

Factors that affect the cost of the procedure are as follows: 

1. Type of Hospital: The costs can differ significantly depending on where the procedure is performed. Private facilities are more expensive than government centres due to better amenities. 

2. Geographic Locations: Factors such as the cost of living can impact prices in different regions. Metropolitan cities are costlier than smaller towns. 

3. Surgeon’s Expertise: Medical experts with extensive experience and higher qualifications may charge more for performing TURBT. 

4. Additional Treatments: In some cases, chemotherapy may be recommended following TURBT to prevent tumour recurrence. The costs of these treatments would add to the final bill.

5. Insurance Coverage: The extent to which insurance covers the procedure can significantly affect out-of-pocket expenses for the patient. 

TURBT is both a diagnostic and a treatment for bladder cancer. It allows for the direct removal of the tumour and provides tissue for pathological examination. As a minimally invasive procedure, it helps enhance patient outcomes with a relatively quick recovery time.

The professionals at HexaHealth understand the challenges of managing bladder cancer. Our team guides patients through the TURBT procedure, from initial consultation and preparation to post-operative care. We provide access to expert urologists, ensuring that each patient receives personalised care and the best possible treatment outcomes.

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