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Surgery is often part of the treatment plan for bladder cancer, but it may not be necessary for everyone. If you’ve been diagnosed with low-grade bladder cancer, you will usually need a procedure called a transurethral resection of bladder tumor, or TURBT, to remove the tumor and learn more about the cancer. In some cases, especially if a small low-grade tumor comes back, other treatments may be used instead of another surgery.
In this article, we’ll review surgery and treatment options for people with low-grade bladder cancer tumors.
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The grade of the cancer refers to how normal or abnormal cancer cells look under a microscope. To determine the grade, your urologist will take a small sample of tissue from your bladder (called a biopsy) to study under the microscope.
The cancer grade helps your cancer care team understand how fast your cancer may grow and spread. In general, the more normal the tumor cells look, the less aggressive the cancer tends to be.
“Low-grade bladder cancer” refers to tumors that look similar to healthy bladder cells under a microscope. These cells are usually organized and grouped in a similar way to healthy bladder tissue.
Low-grade cancers that haven’t spread to the muscle layer of the bladder wall (called non-muscle-invasive bladder cancer, or NMIBC) are usually slow-growing and rarely spread to other parts of the body (metastatic bladder cancer).
On the other hand, high-grade tumor cells appear abnormal and disorganized under a microscope. High-grade bladder cancer is usually more aggressive and has a worse prognosis (outcome) than low-grade tumors because it’s more likely to spread.
Your cancer grade is one factor your cancer care team will use to help choose the best treatment options and estimate your prognosis. It’s important to know that the tumor grade isn’t the same as the cancer stage. The cancer stage describes the tumor’s size and how far the cancer has spread.
There are two main types of surgery used to treat low-grade bladder cancer — transurethral resection of bladder tumor and cystectomy. A TURBT is the standard initial procedure for low-grade bladder cancer.
In a TURBT, the tumor is removed, but your bladder stays in your body, and no cuts are made to your skin. In a cystectomy, your bladder, along with the bladder tumor, is removed through a cut made on the lower abdomen.
In a TURBT, a long, thin tube with a camera is inserted into your bladder through your urethra. An electrified wire loop on the end of the tube can be used to remove the tumor and some nearby tissue. This is called resection. The tissue that is removed will be sent to a laboratory for testing to help determine the cancer’s stage and grade.
After the tumor is removed, the doctor may also use an electrical current to destroy small areas of remaining abnormal tissue. This is called fulguration.
After the procedure, you may receive a single dose of chemotherapy directly into your bladder (called intravesical chemotherapy) within 24 hours. This treatment helps kill any remaining cancer cells. Studies show that this single dose of chemotherapy is effective in preventing low-grade bladder tumors from returning.
Low-grade NMIBC is often treated with a TURBT. In many cases, this treatment can cure low-grade NMIBC. If you have just one small, low-grade tumor (classified as low-risk NMIBC), a TURBT may be the only treatment you need.
If you have a low-grade tumor with features that suggest it’s at an intermediate or high risk of returning after treatment (recurring), you may need further treatments. Concerning features may include:
In addition, carcinoma in situ, or CIS, is a flat bladder tumor that’s always considered high-grade. Because it has a higher risk of becoming more serious, it usually requires additional treatment.
To prevent intermediate- or high-risk NMIBC from returning, you may receive intravesical therapy with an immunotherapy drug or chemotherapy for a few weeks to a few years.
A second TURBT is not needed for everyone with low-grade bladder cancer. Your doctor may recommend one if the first tumor could not be completely removed or if testing shows features that need a closer look.
After the procedure, most people will recover from a TURBT within two to four weeks.
An initial TURBT is usually performed in an operating room under general anesthesia (medicine to put you to sleep so you don’t feel pain). This procedure isn’t considered major surgery. Some people are able to go home the same day, while others may need just a few days to recover in the hospital.
For some people with small low-grade tumors that come back, the doctor may destroy the tumor with an electrical current during an office visit. This is called office fulguration and may be done with local anesthesia (numbing only the area where the surgery is performed).
A cystectomy is the medical term for bladder removal surgery. If only part of the bladder is removed, it’s called a partial cystectomy. If the entire bladder is removed, it’s called a radical cystectomy.
A radical cystectomy also requires a urinary diversion procedure to create a new way for urine to exit your body.
Cystectomy is rarely needed for low-grade bladder cancer. It may be considered if bladder-sparing treatments have been tried and the cancer still cannot be controlled. You may also need a cystectomy with low-grade bladder cancer if your tumor is:
For low- or intermediate-risk low-grade tumors, doctors usually try bladder-sparing treatments before considering radical cystectomy.
The type of cystectomy you need depends on the tumor’s size, number, location, and how far it has grown, as well as your overall health. Partial cystectomy is uncommon and is only an option in certain cases where the tumor can be completely removed while leaving enough healthy bladder tissue.
A cystectomy is a major surgery, and most people need several days to recover in the hospital. Full recovery can take a few weeks or even months. If you have a urinary diversion, you’ll also need time to learn how to adjust to a new way of going to the bathroom.
This process can take a few months. Talk to your cancer care team to learn more about the recovery process for your surgery and what to expect.
No matter which type of surgery you have for low-grade bladder cancer, you’ll need close follow-up for several years. The exact timing and nature of follow-up care will depend on your level of risk.
Follow-up tests depend on your risk level and other health needs. Cystoscopy is the main test used to look for bladder cancer that has come back. People with low-risk cancer may not need routine urine cytology or imaging if they have no symptoms and their cystoscopy results are normal.
If you have a TURBT, your urologist will usually check your bladder again with a cystoscopy (a procedure that uses a long, thin tube with a camera and a light to look inside your bladder) about three to four months later. After that, the timing depends on your risk of the cancer coming back. People with low-risk cancer may need cystoscopy less often if their follow-up tests remain normal.
Because of the risk of recurrence, close follow-up is important even if your cancer is cured with a TURBT. However, if low-grade bladder cancer does come back, it usually isn’t life-threatening if caught early.
Talk to your cancer care team for more information about how often you should have follow-up visits after your bladder cancer treatment.
Most people will need a TURBT at some point in their diagnosis or treatment of low-grade bladder cancer. However, your oncology team may recommend other treatment options for low-grade bladder cancer, including:
In 2025, the U.S. Food and Drug Administration approved an intravesical treatment for adults with recurrent low-grade, intermediate-risk non-muscle-invasive bladder cancer. This medicine is placed directly into the bladder and can destroy tumors without another TURBT in some people. Your cancer care team can help decide whether this type of treatment is an option for you.
Treatments such as radiation therapy, chemotherapy, chemoradiation, and some forms of immunotherapy are generally used for more advanced, muscle-invasive, or certain high-risk bladder cancers. They are not standard treatments for most low-grade non-muscle-invasive bladder cancers.
Talk to your cancer care team about the risks and benefits of each treatment option to find the best choice for you.
Throughout the process of treating low-grade bladder cancer, your provider should offer you the chance to participate in shared decision-making. This means that, rather than the healthcare provider telling you what happens next, they work with you to choose a treatment that works with your priorities and medical needs.
Making medical decisions in this way can help retain your quality of life and honor your goals.
Over the last 10 years, this process has become more and more common. Right now, it occurs for about 69 percent of men and 58 percent of women among the respondents who reported having a conversation with their provider about their treatment wishes and goals.
You can advocate for this with your oncologist by asking for it specifically and by asking questions about the treatment options they offer you.
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The Turnt procedure you can get a perforated bladder which my husband had so see if other procedures are offered. He had one turbt and this happened not sure if anymore
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