Transurethral Resection of Bladder Tumor

  • Jungyo Suh


Transurethral resection of bladder tumor (TURBT) is first-line treatment of all kinds of bladder cancer. Clinical usage of TURBT is not only for treatment but also for diagnosis by accurate staging and grading.

Most of bladder cancer is diagnosed as non-muscle invasive tumor, but control of recurrence and progression is a major issue in bladder cancer management. Single, low-grade, noninvasive tumor could be treated by TURBT alone, but if there are any evidence of higher risk in pathologic specimen, additional treatment (instillation of BCG, chemotherapy, or early cystectomy) is essential.

TURBT is also important for accurate bladder cancer staging. Repeated TURBT (so-called second-look TURBT) and en bloc resection of urothelial carcinoma in bladder (EBRUC) are performed for satisfying these clinical needs. Prostatic urethra sampling and bladder random biopsy are also considered in TURBT procedure for gathering clinical information for decision-making.

There is a consensus that all visible papillary tumors should be resected in TURBT procedure. The EAU guideline strongly recommends acquisition of underlying detrusor muscle and adjuvant tissue of papillary tumor by en bloc resection in small tumor or separate resection in large tumor. Although AUA and NCCN do not mentioned about underlying detrusor muscle in initial TURBT, it should take on re-TURBT procedure or in the case of T1 high-grade tumor.


Transurethral resection of bladder tumor En bloc resection Repeated TURBT Prostate urethra biopsy Bladder random biopsy 


  1. 1.
    Traxer O, Pasqui F, Gattegno B, Pearle MS. Technique and complications of transurethral surgery for bladder tumours. BJU Int. 2004;94:492–6. Scholar
  2. 2.
    Salvador J, Collado A, Che GE. Early complications of endoscopic treatment for superficial bladder tumors. J Urol. 2000;164:1529–32.CrossRefGoogle Scholar
  3. 3.
    Dick A, Barnes R, Hadley H, Bergman RT, An CANIN. Complications of transurethral resection of bladder tumors: prevention, recognition and treatment. J Urol. 1980;124:810–1. Scholar
  4. 4.
    Pansadoro A, Franco G, Laurenti C, Pansadoro V. Conservative treatment of intraperitoneal bladder perforation during transurethral resection of bladder tumor. Urology. 2002;60:682–4.CrossRefGoogle Scholar
  5. 5.
    Bayrak MER, Koç A, Ali U. The actual incidence of bladder perforation following transurethral bladder surgery. J Urol. 2005;174:2260–3. Scholar
  6. 6.
    Avallone MA, Sack BS, El-Arabi A, Charles DK, Herre WR, Radtke AC, Davis CM, See WA. Ten-year review of perioperative complications after transurethral resection of bladder tumors: analysis of monopolar and plasmakinetic bipolar cases. J Endourol. 2017;31:767–73. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sopeña-Sutil R, Medina-Polo J, Justo-Quintas J, Gil-Moradillo J, Garcia-Gonzalez L, Benítez-Sala R, Alonso-Isa M, Lara-Isla A, Tejido-Sanchez A. Healthcare-associated infections after lower urinary tract endoscopic surgery: analysis of risk factors, associated microorganisms and patterns of antibiotic resistance. Urol Int. 2018;100(4):440–4. Scholar
  8. 8.
    Goldwasser B, Bogokowsky B, Sidi AA, Jonas P, Many JVL. Urinary infections following transurethral resection of bladder tuiviors-rate and source. J Urol. 1983;129:1123–4. Scholar
  9. 9.
    Balci M, Tuncel A, Keten T, Guzel O, Lokman U, Koseoglu E, Aslan Y, Atan A. Comparison of monopolar and bipolar transurethral resection of non-muscle invasive bladder cancer. Urol Int. 2017;100:100–4. Scholar
  10. 10.
    Venkatramani V, Panda A, Manojkumar R, Kekre NS. Monopolar versus bipolar transurethral resection of bladder tumors: a single center, parallel arm, randomized, controlled trial. J Urol. 2014;191:1703–7. Scholar
  11. 11.
    Fritsche H, Burger M, Svatek RS, Jeldres C, Karakiewicz PI, Novara G, et al. Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort. Eur Urol. 2010;57:300–9. Scholar
  12. 12.
    Ficarra V, Dalpiaz O, Alrabi N, Novara G, Galfano A, Artibani W. Correlation between clinical and pathological staging in a series of radical cystectomies for bladder carcinoma. BJU Int. 2005;95:786–90. Scholar
  13. 13.
    Dutta SC, Smith JA, Shappell SB, Coffey CS, Chang SAMS, Cookson MS. Clinical under staging of high risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol. 2001;166:490–3.CrossRefGoogle Scholar
  14. 14.
    Badalato G, Patel T, Hruby G, Mckiernan J. Does the presence of muscularis propria on transurethral resection of bladder tumour specimens affect the rate of upstaging in cT1 bladder cancer? BJU Int. 2011;108:1292–6. Scholar
  15. 15.
    Bianco FJ, Justa D, Grignon DJ, Sakr WA, Pontes JE, Wood DP. Management of clinical T1 bladder transitional cell carcinoma by radical cystectomy. Urol Oncol. 2004;22:290–4. Scholar
  16. 16.
    Gupta A, Lotan Y, Bastian PJ, Palapattu GS, Karakiewicz PI, Raj GV, et al. Outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma treated with radical cystectomy. Urology. 2008;71:302–7. Scholar
  17. 17.
    Herr HW, Donat SM. A re-staging transurethral resection predicts early progression of superficial bladder cancer. BJU Int. 2006;97:1194–8. Scholar
  18. 18.
    Schips L, Augustin H, Zigeuner RE, Galle G, Habermann H, Trummer H, et al. Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer? Urology. 2002;59:220–3.CrossRefGoogle Scholar
  19. 19.
    Herr HW. Superficial bladder cancer improves the initial response to bacillus calmette-guerin therapy. J Urol. 2005;174:2134–7. Scholar
  20. 20.
    Sfakianos JP, Kim PH, Hakimi AA, Herr HW. The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus calmette-guerin. J Urol. 2014;191:341–5. Scholar
  21. 21.
    Shen SS, Lerner SP, Muezzinoglu B, Truong LD, Amiel G, Wheeler TM. Prostatic involvement by transitional cell carcinoma in patients with bladder cancer and its prognostic significance. Hum Pathol. 2006;37:726–34. Scholar
  22. 22.
    Nixon RG, Chang SAMS, Lafleur BJ, Smith JA, Cookson MS. Carcinoma in situ and tumor multifocality predict the risk of prostatic urethral involvement at radical cystectomy in men with transitional cell carcinoma of the bladder. J Urol. 2002;167:502–5.CrossRefGoogle Scholar
  23. 23.
    Ngninkeu BN, Lorge F, Moulin P, Jamart J, Cangh PJVAN. Transitional cell carcinoma involving the prostate: a clinicopathological retrospective study of 76 cases. J Urol. 2003;169:149–52. Scholar
  24. 24.
    Palou J, Baniel J, Klotz L, Wood D, Cookson M, Lerner S, et al. Urothelial carcinoma of the prostate. Urology. 2007;69:50–61. Scholar
  25. 25.
    Gofrit ON, Pode D, Pizov G, Zorn KC, Katz R, Shapiro A. Prostatic urothelial carcinoma: is transurethral prostatectomy necessary before bacillus Calmette-Guérin immunotherapy? BJU Int. 2009;103:905–8. Scholar
  26. 26.
    Palou J, Xavier B, Laguna P, Montlleó M, Vicente J. In situ transitional cell carcinoma involvement of prostatic urethra: bacillus Calmette-Guerin therapy without previous transurethral resection of the prostate. Urology. 1995;4:482–4.Google Scholar
  27. 27.
    Kim JC, Steinberg GD. The limits of bacillus calmette-guerin for carcinoma in situ of the bladder. J Urol. 2001;165:745–56.CrossRefGoogle Scholar
  28. 28.
    Lerner SP, Shen S, Ph D. Pathologic assessment and clinical significance of prostatic involvement by transitional cell carcinoma and prostate cancer. Urol Oncol. 2008;26:481–5. Scholar
  29. 29.
    Von RF, Mata DA, Shen S, Li Y, Godoy G, Lerner SP. Transurethral biopsy of the prostatic urethra is associated with final apical margin status at radical cystoprostatectomy. J Clin Urol. 2016;9:404–8. Scholar
  30. 30.
    Librenjak D, Novakovic ZS, Situm M, Milostic K, Duvnjak M. Biopsies of the normal-appearing urothelium in primary bladder cancer. Urol Ann. 2010;2:71–5. Scholar
  31. 31.
    Kumano M, Miyake H, Nakano Y, Fujisawa M. Significance of random bladder biopsies in non-muscle invasive bladder cancer. Curr Urol. 2013;7:57–61. Scholar
  32. 32.
    Van Der MA, Oosterlinck W, Brausi M, Sylvester R, De BC, Eortc-gu M. Significance of bladder biopsies in Ta, T1 bladder tumors: a report from the EORTC genito-urinary tract cancer cooperative group. Eur Urol. 1999;35:267–71.CrossRefGoogle Scholar
  33. 33.
    May F, Treiber U, Hartung R, Schwaibold H. Significance of random bladder biopsies in superficial bladder cancer. Eur Urol. 2003;44:47–50. Scholar
  34. 34.
    Ikeda H. A new technique for transurethral resection of superficial bladder tumor in 1 piece. J Urol. 2000;163:878–9.CrossRefGoogle Scholar
  35. 35.
    Kramer MW, Rassweiler JJ, Klein J, Martov A, Baykov N, Lusuardi L, et al. En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol. 2015;33:1937–43. Scholar
  36. 36.
    Wu Y, Lin T, Chen S, Xu N, Wei Y, Huang J, et al. Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor. Med. 2016;95:e5372.CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Jungyo Suh
    • 1
  1. 1.Department of UrologySeoul National University HospitalSeoulSouth Korea

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