What are the Risks of TURBT (Transurethral Resection of Bladder Tumor)?

TURBT is generally regarded as a low-risk procedure. It is typically performed as a  day surgery procedure, meaning that you will not need to stay in the hospital overnight. As with any surgery that requires anesthesia, a small risk is associated with the anesthesia. This risk is higher if you have other conditions such as asthma, chronic obstructive pulmonary disease, or cardiovascular disease, but is still generally very low risk.

The risks associated specifically with the TURBT procedure also are small. They include bleeding, infection, and bladder perforation. It is important to stop any “blood thinners” that are commonly prescribed for heart conditions, such as aspirin, Coumadin (warfarin), Plavix, and others. Ask your doctor about which of your medications you may need to stop taking before the procedure.

Bleeding is the most common risk. The bladder is blessed with a rich blood supply, which facilitates quick and easy healing. During surgery, however, this creates opportunity for bleeding. After a TURBT, the urine is almost always light to dark pink. The color often will clear if you drink more fluid, thereby diluting the urine. Less commonly, blood clots will form in the bladder, which could block the flow of urine. In these cases, a catheter will need to be placed and the bladder irrigated with saline until the bleeding decreases. In a recent series of 2,821 patients who underwent TURBT, 2.8% (78 of the 2,821 patients) had problems with bleeding, and 3.4% (96 patients) required blood transfusion. Straining to void or move the bowels, deep coughing, or heavy lifting after the procedure may also increase the risk of bleeding.

Urinary tract infections will occasionally occur after TURBT, although the risk is low. To minimize the risk, antibiotics are usually given at the time of the procedure. In patients who are at higher risk, a course of antibiotics may also be given after the procedure for a few days. Most infections that do occur can be treated with antibiotics at home, although rarely will an infection be serious enough to require intravenous antibiotics in the hospital. It is often difficult to diagnose an infection initially because surgery can cause the same irritative symptoms as an infection. If the symptoms get worse instead of better or fail to improve quickly, or if you develop a fever or cloudy urine, you should call your doctor.

A bladder perforation occurs when the resection of the tumor extends through all of the layers of the bladder wall. In the study with 2,821 patients, 1.3% (36 patients) had small perforations in their bladders. A perforation usually occurs as a result of the urologist’s need to resect deeply enough to remove the entire tumor. He or she must also include part of the wall of the bladder so that the pathologist can see how deep the tumor extends into it. Small perforations through the bladder wall heal quickly on their own. Until the perforation heals, a catheter will be left in place, usually for a few days. Larger perforations and those with continued leakage of fluid out of the bladder may require open surgery to close the hole. Complications are more likely to occur in patients who have larger tumors or multiple tumors.

A TURBT is performed with the patient’s legs raised in stirrups. This position is necessary to allow access to the bladder. Occasionally, this position can place pressure to a sensitive area that can cause blistering or numbness. These problems usually resolve on their own without need for other treatments.