Transurethral resection of bladder tumour

Endoscopic resection of visible bladder tumour for diagnosis, staging and local control, with deliberate specimen strategy and assessment of resection quality.

core 4 recorded variations 8 complication modules Also: TURBT · bladder tumour resection · en-bloc TURBT

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Teaching catalogue only. This coverage record is not a patient pathway or operative instruction.

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01 Scope and comparison

Typical place in practice

Initial or repeat management of suspected non-muscle-invasive bladder cancer and selected assessment of more advanced disease.

Alternatives and neighbouring procedures

Office fulguration for selected recurrences, bladder biopsy, surveillance or definitive bladder surgery according to disease context.

02 Recorded variations

Same procedure family, explicit technique branches

These are variations of this canonical operation. Complication modules below identify whether they apply to all branches or only to named approaches.

01 · Transurethral electrosurgical resection

Conventional piecemeal TURBT

Tumour is resected in fractions with separately orientated deep tissue where required.

02 · Transurethral circumferential dissection

En-bloc TURBT

A selected tumour is removed as one specimen to preserve architecture and orientation.

03 · Transurethral with optical adjunct

Enhanced-visualisation TURBT

An enhanced imaging mode supplements white-light inspection to identify additional mucosal disease.

04 · Planned second transurethral resection

Repeat resection TURBT

The prior site and bladder are reassessed to address residual disease or staging uncertainty.

03 Orientation sequence

High-level sequence

Coverage outline only; not a step-by-step technical guide.

Map the bladder and document tumour number, site and morphology
Plan specimen handling and energy before resection
Resect visible disease while protecting bladder wall and orifices
Obtain appropriate deep tissue without uncontrolled perforation
Secure haemostasis and document completeness, perforation status and next pathway

04 Operative notes

Operative notes

Concise operative notes covering the key steps, landmarks and watch points, in the order you encounter them.

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Operative note 09 Core CORE (added 2026)

TURBT

What it does: resect a bladder tumour through the resectoscope.

Examine with both hands, in and out. A fixed mass changes stage and plan.
Survey the whole bladder first, half full. Same order every time: trigone and both orifices, posterior wall, left wall, dome (bubble), right wall, front wall (70 degree lens, press above the pubis), neck.
Find both ureteric orifices before cutting near them.
Resect in order: tumour, then base, then edge. Base in its own pot.
Muscle must be in the specimen. No muscle = no stage. It is the quality standard. Deep enough: coarse muscle bundles. Yellow fat: too deep.
Small tumour: cold cup or loop, base included.
Lateral wall? Warn the anaesthetist. The obturator nerve fires a leg kick as you cut. Ask for a short paralysing dose. Fill less. Bipolar in saline, lowest current that cuts.
Avoid perforation: half fill. Loop placed beyond the tumour, drawn back towards you: cut on the return, sheath still. Short swipes. Never push the loop into a thin wall.
Suspect perforation (view deflates, fat, distension)? Stop. Catheter. Drain. Image.
Clear the chips through the sheath. Last look for a breach before any chemo goes in.
En-bloc (cut around, lift off) for small tumours.

Kit: 24-26 Fr continuous-flow resectoscope. 30 and 70 degree lenses. Bipolar loop in saline; rollerball or button. Cold-cup forceps. Suction on the outflow. Separate labelled pots: tumour, base, each biopsy. 3-way 20-22 Fr catheter for a big resection. Owner-specified.

Watch: Bimanual after, not just before.

2026 update: One dose of chemo in the bladder after resection. Within 2 h. Not if perforated or bleeding hard. Gemcitabine is now first choice in many units. (Mitomycin supply ran short.)