HomeAnswersUrologyturbt biopsyMom had bladder tumor surgery. Doctor suggests TURBT. Why?

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

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At February 26, 2023
Reviewed AtOctober 16, 2023

Patient's Query

Hello doctor,

My mother had a bladder tumor and had the surgery two months ago. The pathological result is urothelial carcinoma, low grade (G2), pTa. The doctor who did the surgery said he wants to do the TURBT once more if something is left over. Is this a normal procedure to repeat the TURBT without doing a cystoscopy to see if it is necessary?

Thank you.

Answered by Dr. Karthik Rajan

Hello,

Welcome to icliniq.com.

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.

Thank you.

Patient's Query

Hello doctor,

Thank you for your reply.

What treatment would you recommend after the second TURBT? Is it immunotherapy, chemotherapy, or nothing?

Thank you.

Answered by Dr. Karthik Rajan

Hello,

Welcome back to icliniq.com.

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.

Thank you.

Patient's Query

Hello doctor,

It was four tumors close to each other, which looked like one. So the size together was approximately 3.5 cm. What treatment would you recommend?

Thank you.

Answered by Dr. Karthik Rajan

Hello,

Welcome back to icliniq.com.

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.

Thank you.

Patient's Query

Hello doctor,

What are the secondary effects of immunotherapy?

Thank you.

Answered by Dr. Karthik Rajan

Hello,

Welcome back to icliniq.com.

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.

Thank you.

Patient's Query

Hello doctor,

Can chemotherapy or immunotherapy have secondary effects on other organs?

Thank you.

Answered by Dr. Karthik Rajan

Hello,

Welcome back to icliniq.com.

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.

Thank you.

Patient's Query

Hello doctor,

What are the possible systemic effects of immunotherapy?

Thank you.

Answered by Dr. Karthik Rajan

Hello,

Welcome back to icliniq.com.

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.

Thank you.

Patient's Query

Hello doctor,

Could you please tell me how many sessions of immunotherapy are necessary?

Thank you.

Answered by Dr. Karthik Rajan

Hello,

Welcome back to icliniq.com.

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.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Karthik Rajan
Dr. Karthik Rajan

Urology

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