What is the need for repeating TURBT after a bladder tumor removal surgery?

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I have gone through your query.

It is indicated to do a TURBT (transurethral resection of the bladder tumor) once again because if there was any residual tumor in the previous tumor site, it had to be removed completely. Even if there is no visible tumor, the scar of the previous site will be biopsied to confirm complete tumor removal. This is necessary because 20 to 40 percent of some microscopic tumor gets left behind even after complete removal. As further management is based on the stage of the disease, this is essential. As the tumor is low grade, the chances of any residual tumor are low, but necessary for the accuracy of staging the disease.

Hope this helps; feel free to revert with any questions.

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Based on the current biopsy report, she will need intra-vesical therapy. The exact regime will depend on the size of the tumor and whether it is single or multiple.

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If that is the case, she should undergo intra-vesical chemotherapy or immunotherapy for one year. Since the pathology is grade 2, with multiple tumors, immunotherapy would be more effective than chemotherapy. In addition, she will have to be on close follow-up with regular cystoscopic examination as per the schedule advised by the urologist.

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The side effects are variable. Most patients will have a burning sensation and mild bleeding during urination. Less than 5 % have a chance of severe side effects like fever and weakness. In general, immunotherapy has more side effects but is more effective.

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As they are instilled directly into the urinary bladder, they do not affect other organs. We take maximum precautions to ensure that the drug instilled into the bladder does not get absorbed into the blood and acts only on the bladder wall. In immunotherapy using BCG (Bacillus Calmette-Guerin), there is less than a 5 % chance of systemic effects, but it is treatable and leaves no long-term residual effects.

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The drug is a vaccine (type of bacteria) that acts on the cancer cells and destroys them. If by any chance it gets absorbed into the bloodstream, it can cause fever, chills, and muscle pain. This is unusual as strict precautions are taken to ensure it does not happen. Very rarely, it will have a severe infection with the symptoms mentioned above and lymph gland swelling. This requires treatment with antibiotics for a few months but generally resolves without any permanent effects.

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It would depend on the final biopsy results. It is usually given as a course every week for six weeks, then three doses weekly for three weeks every three months. This is done for a year, with a cystoscopic examination to check for recurrence every three months.

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