About the Procedure

What Is TURBT?

TURBT (Transurethral Resection of Bladder Tumor) is the cornerstone procedure for evaluating and treating bladder cancer. A resectoscope is passed through the urethra into the bladder — no incisions required — and the tumor is removed using an electrosurgical loop. The resected tissue is sent to pathology for analysis. TURBT is performed under general or spinal anesthesia in the operating room at UTMC.

Three Objectives

What TURBT Accomplishes

01

Diagnosis

Tissue obtained during TURBT is the definitive way to confirm bladder cancer. Pathology identifies the histologic type, most commonly urothelial (transitional cell) carcinoma.

02

Grading

The pathologist assigns a grade (low or high) based on how abnormal the cancer cells appear. Grade drives nearly every subsequent treatment decision — from surveillance frequency to intravesical therapy type.

03

Staging

Pathology determines whether cancer is confined to the inner lining (non-muscle invasive, Ta/T1/CIS) or has grown into the muscle wall (muscle invasive, T2+). This distinction is critical — it determines whether bladder preservation is possible.

What to Expect

How TURBT Is Performed

TURBT is performed as an outpatient or short-stay hospital procedure at UTMC. Most patients go home the same day or after one overnight stay.

1

Anesthesia

General or spinal anesthesia is administered. You will be completely comfortable throughout the procedure. Your anesthesiologist will review your history at your pre-anesthesia testing (PAT) appointment prior to surgery.

2

Cystoscopy & Tumor Mapping

A rigid cystoscope is passed through the urethra into the bladder. The entire bladder lining is inspected systematically. All visible tumors are identified and their location, size, and appearance are documented before resection begins.

3

Resection

Each tumor is resected using an electrosurgical loop passed through the resectoscope. The tumor is removed in layers — first the exophytic (visible) portion, then the base and surrounding margin, including detrusor muscle when appropriate to ensure complete staging.

4

Pathology Submission

All resected tissue is sent to pathology. The surgical report specifies which fragments contain muscle so the pathologist can confirm muscle was included in the specimen — an important quality indicator for staging accuracy.

5

Catheter Placement (When Indicated)

A urethral catheter is placed at the end of the procedure in selected cases — this depends on the size and extent of resection, the location of the tumor, and whether immediate postoperative intravesical chemotherapy is administered. Not every patient requires a catheter. Your surgeon will determine whether one is needed based on your specific case, and will discuss this with you in advance.

Immediate Postoperative Treatment

Single-Dose Intravesical Chemotherapy at Time of TURBT

For appropriately selected patients, a single instillation of intravesical chemotherapy can be administered directly into the bladder in the operating room immediately following TURBT. This is a guideline-recommended intervention that reduces the risk of recurrence by destroying any floating cancer cells that may have been released during resection.

Who is a candidate?

Single-dose immediate instillation is most appropriate for patients with:

Small, solitary, low-grade papillary tumor (suspected Ta low-grade)
No prior history of bladder cancer or low recurrence risk profile
No suspected perforation or significant bleeding during resection
No contraindication to the agent used (typically gemcitabine or mitomycin-C)

Who is NOT a candidate?

Suspected or confirmed muscle-invasive disease
Bladder perforation during resection
Extensive resection with significant bleeding
Known CIS (carcinoma in situ) or high-grade disease prior to resection
Multiple or large tumors with high recurrence risk (these patients proceed directly to formal intravesical therapy planning)

When immediate instillation is given, it does not replace a full course of intravesical therapy — it is additive for low-risk patients and does not affect downstream treatment planning. For detailed information on our full intravesical therapy options, see our intravesical therapy page.

NCCN Guidelines

Who Needs a Re-Resection (Second TURBT)?

Re-resection — also called a second-look TURBT — is performed 4 to 6 weeks after the initial TURBT in certain high-risk scenarios. NCCN guidelines recommend repeat resection when the initial resection may be incomplete or when the pathologic result warrants more definitive staging. Studies consistently show that re-resection upstages a significant proportion of patients and improves outcomes.

Recommended

T1 High-Grade Disease

Any T1 high-grade tumor should undergo re-resection to confirm staging and ensure complete resection. Up to 25–35% of T1 tumors are upstaged to muscle-invasive disease on re-resection. This changes the treatment entirely.

Recommended

No Muscle in Specimen

If no detrusor muscle is present in the initial pathology specimen, the staging is incomplete and re-resection is required regardless of grade. Absence of muscle is a quality indicator that resection was insufficient for staging.

Consider

Large or Multifocal Tumors

Large (>3 cm), multifocal, or incompletely resected tumors where the surgeon has concern about margins or completeness. Re-resection confirms that the bladder is clear before initiating intravesical therapy.

Not Routine

Low-Grade Ta Disease

Small, solitary, low-grade Ta tumors that are completely resected with muscle present in the specimen do not routinely require re-resection. These patients proceed to surveillance and intravesical therapy per risk stratification.

Required

Staging for Cystectomy Planning

When cystectomy is being considered for high-risk NMIBC, re-resection is performed to confirm pathology and ensure the most accurate staging before a major surgical decision is made.

Consider

Variant Histology

Tumors with variant histology (squamous differentiation, micropapillary, plasmacytoid, etc.) warrant re-resection and expedited multidisciplinary review given their more aggressive clinical behavior.

Advanced Technology

Blue Light Cystoscopy (Cysview®)

University Urology uses blue light cystoscopy with Cysview® (hexaminolevulinate) for selected patients — the only practice in the region offering this technology. Cysview is instilled into the bladder prior to the procedure and is absorbed preferentially by cancer cells. Under blue light, malignant tissue fluoresces pink-red against the dark blue background of normal mucosa, making tumors visible that would be missed under standard white light.

When We Use It

Patients with cytologic abnormalities (positive or atypical urine cytology) and a negative white light cystoscopy. Known or suspected CIS, which is notoriously flat and difficult to visualize. Surveillance after prior high-grade disease.

Clinical Benefit

Blue light cystoscopy can detect additional tumors not visible under white light alone, particularly flat lesions and CIS. Improved detection at TURBT reduces recurrence rates and improves staging accuracy in appropriately selected patients.

The Technology

Cysview (hexaminolevulinate 8 mg) is instilled into the bladder approximately 1 hour before the procedure. The Karl Storz IMAGE1 S™ system generates the blue light spectrum used during endoscopy.

Only in the Region

University Urology is the only practice in East Tennessee offering blue light cystoscopy. Patients referred from outside the region for high-risk bladder cancer evaluation have access to this technology at UTMC.

◆ Only practice in East Tennessee offering blue light cystoscopy

Recovery

What to Expect After TURBT

Most patients recover quickly from TURBT. The following is a general guide — your surgeon will provide specific instructions based on the extent of your resection.

First 24–48 Hours

Urinary burning, urgency, and frequency are common and expected
Pink-tinged or blood-tinged urine is normal — it should gradually clear
If a catheter was placed, it will be removed before you go home or the morning after surgery
Drink plenty of fluids to help flush the bladder
Avoid heavy lifting and strenuous activity

First 1–2 Weeks

Most patients return to desk work within a few days
Avoid prolonged sitting, heavy exertion, or straining
Complete the prescribed antibiotic course if given
Avoid blood thinners unless specifically told otherwise by your surgeon
Urinary symptoms typically improve significantly within 1–2 weeks

Pathology Results

Results are typically available in 10–14 business days
Your surgeon will contact you directly to discuss grade, stage, and next steps
Do not call the office before the window closes — results require physician review before communication
Results are also posted to your patient portal

Follow-Up Planning

A follow-up cystoscopy (surveillance) is scheduled based on your risk classification
Intravesical therapy is initiated once pathology is finalized and the bladder has healed
Re-resection is scheduled 4–6 weeks later if indicated by pathology
Systemic staging (CT urogram, PSMA PET) is ordered if muscle invasion is suspected

When to call or go to the ER

Contact our office at (865) 305-9254 or go to the nearest emergency room if you experience: heavy or worsening bleeding with clots · inability to urinate · fever above 101.5°F · severe pain not controlled with prescribed medication · signs of sepsis (chills, confusion, rapid heart rate). After hours, call our main number and follow prompts for the on-call provider.

Your Surgical Team

Who Performs TURBT at University Urology

TURBT is performed by all University Urology physicians across our locations. High-grade disease, suspected muscle invasion, variant histology, and cases requiring blue light cystoscopy are managed by our fellowship-trained urologic oncologists at UTMC.

Urologic Oncology

Transurethral Resection of Bladder Tumor (TURBT)