Transurethral bladder resection


Transurethral bladder resection is a surgical procedure used to view the inside of the bladder, remove tissue samples, and/or remove tumors. Instruments are passed through a cystoscope (a slender tube with a lens and a light) that has been inserted through the urethra into the bladder.


Transurethral resection is the initial form of treatment for bladder cancers. The procedure is performed to remove and examine bladder tissue and/or a tumor. It may also serve to remove lesions, and it may be the only treatment necessary for noninvasive tumors. This procedure plays both a diagnostic and therapeutic role in the treatment of bladder cancers.


Bladder cancer is the sixth most commonly diagnosed malignancy in the United States. According to the American Cancer Society, about 57,400 new cases of bladder cancer will be diagnosed in the United States in 2003.

Industrialized countries such as the United States, Canada, France, Denmark, Italy, and Spain have the highest incidence rates for bladder cancer. Rates are lower in England, Scotland, and Eastern Europe. The lowest rates occur in Asia and South America.

Smoking is a major risk factor for bladder cancer; it increases one's risk by two to five times and accounts for approximately 50% of bladder cancers found in men and 30% found in women. If cigarette smokers quit, their risk declines in two to four years. Exposure to a variety of industrial chemicals also increases the risk of developing this disease. Occupational exposures may account for approximately 25% of all urinary bladder cancers.

The incidence of bladder cancer in the white population is almost twice that of the black population, and is more than 2.5 times more likely to be diagnosed in men than women. For other ethnic and racial groups in the United States, the incidence of bladder cancer falls between that of whites and blacks.

There is a greater incidence of bladder cancer with advancing age. Of newly diagnosed cases in both men and women, approximately 80% occur in people aged 60 years and older.


Cancer begins in the lining layer of the bladder and grows into the bladder wall. Transitional cells line the inside of the bladder. Cancer can begin in these lining cells.

During transurethral bladder resection, a cystoscope is inserted through the urethra into the bladder. A clear solution is infused to maintain visibility, and the tumor or tissue to be examined is cut away using an electric current. A biopsy is taken of the tumor and muscle fibers in order to evaluate the depth of tissue involvement, while avoiding perforation of the bladder wall. Every attempt is made to remove all visible tumor tissue, along with a small border of healthy tissue. The resected tissue is examined under the microscope for diagnostic purposes. An indwelling catheter may be inserted to ensure adequate drainage of the bladder postoperatively. At this time, interstitial radiation therapy may be initiated if necessary.


If there is reason to suspect a patient may have bladder cancer, the physician will use one or more methods to determine if the disease is actually present. The doctor first takes a complete medical history to check for risk factors and symptoms, and does a physical examination . An examination of the rectum and vagina (in women) may also be performed to determine the size of a bladder tumor and to see if, and how far, it has spread. If bladder cancer is suspected, the following tests may be performed:

Most of the time, the cancer begins as a superficial tumor in the bladder. Blood in the urine is the usual warning sign. Based on how they look under the microscope, bladder cancers are graded using Roman numerals 0 through IV. In general, the lower the number, the less the cancer has spread. A higher number indicates greater severity of cancer.

Because it is not unusual for people with one bladder tumor to develop additional cancers in other areas of the bladder or elsewhere in the urinary system, the doctor may biopsy several different areas of the bladder lining. If the cancer is suspected to have spread to other organs in the body, further tests will be performed.

Because different types of bladder cancer respond differently to treatment, the treatment for one patient could be different from that of another person with bladder cancer. Doctors determine how deeply the cancer has spread into the layers of the bladder in order to decide on the best treatment.

Standard with any surgical procedure, the patient is asked to sign a consent form after a thorough explanation of the planned procedure.


As with any surgical procedure, blood pressure and pulse will be monitored. Urine is expected to be blood-tinged in the early postoperative period. Continuous bladder irrigation (rinsing) may be used for approximately 24 hours after surgery. Most operative sites should be completely healed in three months. The patient is followed closely for possible recurrence with visual examination, using a special viewing device (cystoscope) at regular intervals. Because bladder cancer has a high rate of recurrence, frequent screenings are recommended. Normally, screenings would be needed every three to six months for the first three years, and every year after that, or as the physician considers necessary. Cystoscopy can catch a recurrence before it progresses to invasive cancer, which is difficult to treat.


All surgery carries some risk due to heart and lung problems or the anesthesia itself, but these risks are generally extremely small. The risk of death from general anesthesia for all types of surgery, for example, is only about one in 1,600. Bleeding and infection are other risks of any surgical procedure. If bleeding becomes a complication, bladder irrigation may be required postoperatively, during which time the patient's activity is limited to bed rest. Perforation of the bladder is another risk, in which case the urinary catheter is left in place for four to five days postoperatively. The patient is started on antibiotic therapy preventively. If the bladder is lacerated accompanied by spillage of urine into the abdomen, an abdominal incision may be required.

Normal results

The results of transurethral bladder resection will depend on many factors, including the type of treatment used, the stage of the patient's cancer before surgery, complications during and after surgery, the age and overall health of the patient, as well as the recurrence of the disease at a later date. The chances for survival are improved if the cancer is found and treated early.

Morbidity and mortality rates

After a diagnosis of bladder cancer, up to 80% of patients with superficial tumors survive for at least five years. The five-year survival rate may be as high as 75% for patients whose tumors have invaded the bladder muscle. The five-year survival rates are 40% or less for patients with more-invasive tumors or metastatic tumors. The five-year survival rate refers to the percentage of patients who live at least five years after their cancer is found, although many people live much longer. Five-year relative survival rates do not take into account patients who die of other diseases. Every person's situation is unique and the statistics cannot predict exactly what will happen in every case; these numbers provide an overall picture.

Mortality rates are two to three times higher for men than women. Although the incidence of bladder cancer in the white population exceeds those of the black population, black women die from the disease at a greater rate. This is due to a larger proportion of these cancers being diagnosed and treated at an earlier stage in the white population. The mortality rates for Hispanic and Asian men and women are only about one-half those for whites and blacks. Over the past 30 years, the age-adjusted mortality rate has decreased in both races and genders. This may be due to earlier diagnosis, better therapy, or both.

Of the 57,400 cases of bladder cancer diagnosed each year in the United States, approximately 12,500 will die.


Surgery, radiation therapy, immunotherapy, and chemotherapy are the main types of treatment for cancer of the bladder. One type of treatment or a combination of these treatments may be recommended, based on the stage of the cancer.

After the cancer is found and staged, the cancer care team discusses the treatment options with the patient. In choosing a treatment plan, the most significant factors to consider are the type and stage of the cancer. Other factors to consider include the patient's overall physical health, age, likely side effects of the treatment, and the personal preferences of the patient.

In considering treatment options, a second opinion may provide more information and help the patient feel more confident about the treatment plan chosen.

Alternative methods are defined as unproved or disproved methods, rather than evidence-based or proven methods to prevent, diagnose, and treat cancer. For some cancer patients, conventional treatment is difficult to tolerate and they may decide to seek a less unpleasant alternative. Others are seeking ways to alleviate the side effects of conventional treatment without having to take more drugs. Some do not trust traditional medicine, and feel that with alternative medicine approaches, they are more in control of making decisions about what is happening to their bodies.

A cancer patient should talk to the doctor or nurse before changing the treatment or adding any alternative methods. Some methods can be safely used along with standard medical treatment. Others may interfere with standard treatment or cause serious side effects.

The American Cancer Society (ACS) encourages people with cancer to consider using methods that have been proven effective or those that are currently under study. They encourage people to discuss all treatments they may be considering with their physician and other health care providers. The ACS acknowledges that more research is needed regarding the safety and effectiveness of many alternative methods. Unnecessary delays and interruptions in standard therapies could be detrimental to the success of cancer treatment.

At the same time, the ACS acknowledges that certain complementary methods such as aromatherapy, biofeedback, massage therapy, meditation, tai chi, or yoga may be very helpful when used in conjunction with conventional treatment.



Hanno, Philip M., S. Bruce Malkowicz, and Alan J. Wein, (editors). Clinical Manual of Urology, 3rd ed. Philadelphia: McGraw-Hill, Inc., 2001.

Hicks, M. Bladder Cancer. Cambridge, UK: Cambridge University Press, 2004.

Schoenberg, Mark P. The Guide to Living with Bladder Cancer. Baltimore, MA: Johns Hopkins University Press, 2001.


Bach, Peter B., Deborah Schrag, Otis W. Brawley, Aaron Galaznik, Sofia Yakren, and Colin B. Begg. "Survival of Blacks and Whites after a Cancer Diagnosis." Journal of American Medical Association 285 (2001): 324–328.

Smith, Shannon D., Marcia A. Wheeler, Janet Plescia, John W. Colberg, Robert M. Weiss, and Dario C. Altieri. "Urine Detection of Surviving and Diagnosis of Bladder Cancer." Journal of American Medical Association 285 (2001): 324–328.


American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329-4251. (800) 227-2345. .

American Foundation for Urologic Disease. 1128 North Charles St., Baltimore, MD 21201. (410) 468-1800. (800) 242-2383. Fax: (410) 468-1808. E-Mail: http://admin@afud. org. .

National Cancer Institute Public Inquiries Office. Suite 3036A. 6116 Executive Boulevard, MSC8322. Bethesda, MD 20892-8322. (800) 422-6237. .

National Comprehensive Cancer Network. 50 Huntingdon Pike, Suite 200, Rockledge PA 19046. (215) 728-4788. Fax: (215) 728-3877. Email: .

National Institutes of Health (NIH), Department of Health and Human Services. 9000 Rockville Pike. Bethesda, MD 20892.


Aetna InteliHealth Inc. Bladder Cancer, 2003 [cited April 24, 2003] .

American Cancer Society, Inc. (ACS) Cancer Refererence Information, 2003 [cited April 24, 2003] .

Kathleen D. Wright, RN Crystal H. Kaczkowski, MSc


Transurethral bladder resections are usually performed in a hospital by a urologist, a medical doctor who specializes in the diagnosis and treatment of diseases of the urinary systems in men and women, and treats structural problems and tumors or stones in the urinary system. Urologists can prescribe medications and perform surgery. If a transurethral bladder resection is required by a female patient, and there are complicating factors, a urogynecologist may perform the surgery. Urogynecologists treat urinary problems involving the female reproductive system.


User Contributions:

Errol Superville
Report this comment as inappropriate
Feb 5, 2009 @ 7:19 pm
When are BCG infusions used in the treatment of bladder cancer?

Compliments on the thorough manner in which you dealt with the subject.

Errol Superville
Don Karstedt
Report this comment as inappropriate
May 15, 2009 @ 9:09 am
My Dr. has determined, after 28 bladder resections to remove tumors, that it is necessary to remove my bladder and right kidney. Do you have any experience or lititure concerning this procedure?
Report this comment as inappropriate
Sep 13, 2010 @ 2:14 pm
We were at the UNC Cancer hospital last Thursday. We are wating for the call from the hospital telling us our surgery date & time for another series of retraction or the removal of the bladder. We have not researched a lot about having the entire bladder removed, and our doctor did not offer a lot of information last Thursday, because we had other family memebers show up for this consultation, and I hesitated to ask some of what I need to know. Looking on line last night, we discovered they take much more then just the bladder when they do this surgery? Do you know the full extent of what all they do take? Thank you.
Report this comment as inappropriate
Sep 27, 2010 @ 11:11 am
how is post-op pain treated? what is the expected recovery tima?
Report this comment as inappropriate
Oct 26, 2011 @ 1:01 am
I have Nephrogenic Adenoma and will be having a transurethral resection done. What will be done an how much pain will I have? Will I have a cathider after? If so, for how long? Thank you in adance for your help.
Robert McGregor
Report this comment as inappropriate
Nov 6, 2014 @ 3:15 pm
I have had a transurethral resection of a bladder tumor(benign) in January 2010 , since then every six months I have received BCG treatment, for a total of 27 sessions, including cystoscopy ,by the urologist every six months after a series of 3 BCG treatments, according to the doctor, all is clear, , but I now suffer from painful and burning urination, overactive bladder, and very sensitive pubic area above the genitals, very unpleasant condition, my sexual life has been ruined , I am 74 yrs old and in good shape otherwise, I therefore question myself If I should continue with more 3 consecutive days of BCG treatment.
Report this comment as inappropriate
Jun 10, 2015 @ 10:22 pm
If all goes well during a TUR, how long before one can drive or return to light-duty work?
Report this comment as inappropriate
Feb 2, 2016 @ 8:20 pm
I'm having my first independent resection in the morning. My first was during my bladder suspension and hysterectomy a year ago. Just trying to find out what to expect
ALbert Vergara
Report this comment as inappropriate
May 18, 2016 @ 3:03 am
I went through a transurethral resection of a bladder tumor(benign) and cant sleep because every 15 minutes to half hour I have to urinate. it is usually very small amounts when I do, some times no control and have to run to restroom. they have given me several medications to alleviate the need to go but it has not changed the need to go frequently. Will this get better, is there any medication that helps with this.
Joyce Frink
Report this comment as inappropriate
Dec 23, 2017 @ 9:21 pm
I had a transurethral resection of a bladder tumor (cancerous). After the resection of the bladder tumor, I had a resection of my bladder twice. The first resection was to remove the tumor in March, 2012. I then had two resections of my bladder, the first was done two weeks after the tumor was removed and the second was done on April, 25, 2012. The procedures was performed by two different doctors at two different hospital. Was the two bladder resections a partial removal of my bladder? I was told that the cancer was invasive to other parts of my bladder.
Report this comment as inappropriate
Apr 2, 2018 @ 7:07 am
How long should it take before urine is consistently without blood?

Comment about this article, ask questions, or add new information about this topic: