Transurethral Resection of Bladder Tumours

, Weranja Ranasinghe2 and Peter Wong2

Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia

Box Hill, Department of Urology, Eastern Health, Box Hill, VIC, Australia



Transurethral resection of bladder tumour (TURBT) is performed for diagnosis and treatment of bladder cancer. The objective when performing TURBT is to ascertain accurate histological diagnosis of the tumour (type, grade and stage), and to completely resect non-muscle invasive tumours. It may also be used to debulk large tumours prior to radiotherapy and as a palliative measure for symptom control (e.g. bleeding).

Preoperative Preparation

Pre- operatively urine analysis should be performed on all patients and any positive urine cultures treated with the appropriate antibiotics. On induction, antibiotic prophylaxis is recommended according to the local guidelines such as aminoglycosides (gentamicin) or cephalosporins (cephazolin, ceftriaxone).

Anticoagulants such as Warfarin, antiplatelet agents and the new orally active anticoagulants (NOACs) should be stopped pre operatively taking into account the half life of the medication according to the indication. Aspirin is generally continued, but can be subject to the surgeon’s preference. Intra-operative TEDS or sequential compression device are recommended for prophylaxis for thromboembolic events.

Informed consent should be obtained from the patient pre operatively, discussing the specific risks of the procedure which include bleeding, infection, TUR syndrome (less likely during TURBT) and bladder perforation. It is generally recommended to have upper tract imaging to exclude the presence of hydronephrosis or tumour. The presence of hydronephrosis may be a clue to the presence of muscle invasive disease near the ureteric orifice for example.


Both spinal and general anaesthesia can be used for TURBT. However, spinal anaesthesia is less of an option for difficult resections such as lateral bladder wall resections where there may be need to paralyse the patient to negate the obturator reflex. In such cases, general anaesthesia with use of an endotracheal tube or LMA (Laryngeal mask airway) is favourable to allow the surgeon the option of temporary paralysis if needed.


The patient is placed in the dorsal lithotomy position which allows the surgeon to adjust the legs as needed during the procedure. Care must be taken to ensure all pressure points are appropriately padded. The ideal height of the irrigation fluid is 60 cm above the level of the pubic symphysis.

Bimanual palpation

It is essential that a bimanual palpation of the bladder is performed and documented before and after TURBT. Tumours that are palpable are likely invasive and if palpable after TURBT this suggests deep muscle invasion or extravesical invasion (pT3). Noting if a mass is mobile or fixed to the pelvis may give further prediction on the degree of difficulty a cystectomy may pose.

Equipment (Figs. 8.1, 8.2, and 8.3)

  • Rigid cystoscope

  • Cystoscope sheath

  • Obturator

  • Bridge

  • Telescope – 30 degree and 70 degree

  • Resectoscope sheath (usually continuous flow)

  • Working element

  • Loop

  • Roller ball

  • High frequency cable

  • Ellik’s evacuator or Toomey syringe

  • Glycine 1.5% in water (~200 mOsm/L)

  • Irrigation Tube

  • Camera and light lead


Fig. 8.1
TURBT set up


Fig. 8.2
Basic equipment for rigid cystoscopy


Fig. 8.3
Equipment for cold cup biopsy showing biopsy forceps and bugbee electrode

Mar 15, 2018 | Posted by in UROLOGY | Comments Off on Transurethral Resection of Bladder Tumours

Full access? Get Clinical Tree

Get Clinical Tree app for offline access