A transurethral resection of bladder tumor (TURBT) is the most common treatment for non-muscle-invasive bladder cancer (NMIBC). During this procedure, a urologist removes abnormal tissue — which may contain cancer cells — from the bladder wall using a long, thin instrument inserted through the urethra (the tube that carries urine out of the body).

Although TURBT is generally considered a safe procedure, any surgery comes with some risk of complications. In this article, we’ll explore five possible side effects and complications of TURBT. Knowing what to expect can help you and your loved ones recognize potential problems and understand when to contact your healthcare provider.

What Are the Aftereffects of TURBT Surgery?

After a TURBT, some people experience mild side effects as the bladder heals, including:

• A burning or painful sensation when urinating
• Hematuria (blood in the urine)
• Lower urinary tract symptoms, such as leaking urine or a need to urinate more often or more urgently

These side effects are usually mild and go away within a few weeks. It’s common for them to come and go for up to one month after the procedure.

Risk for Complications

If the bladder tumor is large or located in a hard-to-reach area, the risk of complications may be higher. Although serious complications are uncommon, they can happen. One study of more than 9,000 people who had a TURBT found that about 8 percent experienced a serious complication. It’s worth noting that the underlying factors behind complications vary widely, including differing tumor sizes, previous surgeries, and other aspects of your procedure and health history. This variability may make it difficult for the average person to estimate risk, making it especially important to consult closely with your urologist and surgeon.

Continue reading to learn more about the most common complications of TURBT.

1. Urinary Tract Infection

Urinary tract infections (UTIs) occur when bacteria infect the urinary system. UTIs are one of the most common complications after a TURBT. Still, they’re not very frequent. One study found that only about 4.5 percent of people developed a UTI within 30 days of the procedure.

One study found that About 4.5 percent of people who underwent TURBT developed a urinary tract infection within 30 days of the surgery.

Healthcare providers take every precaution to prevent infection during surgery. However, a TURBT involves inserting surgical instruments into the bladder, which can introduce bacteria. Using a catheter (a thin, flexible tube to drain urine from your bladder) for a day or two after surgery can also increase your risk of developing a UTI.

Other risk factors include:

• Having a larger bladder tumor
• Being age 75 or older
• Having had radiation therapy in the past

After you have a TURBT procedure, you should watch for UTI symptoms, such as:

• A need to urinate frequently
• Pain or burning when urinating
• Fever
• Chills
• Cloudy or foul-smelling urine

Most UTIs can be treated easily with a short course of antibiotics. Certain symptoms, like mild burning or light bleeding, may be expected postprocedure side effects and not related to a UTI. However, if you notice any concerning symptoms, contact your care team right away so treatment can begin promptly.

2. Bleeding

Some bleeding is normal after a TURBT. Bleeding happens because the bladder lining needs time to heal after a tumor is removed. During the procedure, the surgeon uses a special tool to seal off the blood vessels that are cut. Even so, it’s common to see some blood in the urine for a few days after surgery. This usually gets better as healing continues.

Heavy or long-lasting bleeding may be a sign of a complication. Contact your healthcare provider if you notice:

• An increase in bleeding
• Blood clots in the urine
• Severe pain when urinating

Sometimes, heavier bleeding occurs if a scab from surgery falls off during the healing process. In many cases, no further treatment is needed — your care team may just monitor you closely. If the bleeding doesn’t stop, you may need a follow-up procedure to seal the blood vessels again. In rare cases, bleeding can be serious enough to require a blood transfusion. One study showed blood transfusions were needed in around 1 percent of surgeries.

Blood in your urine is also a common side effect of intravesical chemotherapy and Bacillus Calmette-Guerin (BCG) treatment, which are immunotherapy treatments that are sometimes given after TURBT to target remaining bladder cancer cells after the tumor is removed. These treatment options are more common for intermediate-risk and high-risk non-muscle-invasive bladder cancer. Keep your surgeon’s office informed of posttreatment bleeding to make sure it’s in line with what’s expected following BCG therapy or other immunotherapy treatments.

3. Urinary Retention

Urinary retention means being unable to fully empty the bladder. TURBT can sometimes cause this complication in a few different ways.

One of the ways you can develop urinary retention is if blood clots form in your bladder as a result of TURBT complications of bleeding. The blood clot can block the urethra, making it difficult or impossible to urinate.

Urethral swelling and inflammation after a TURBT can also lead to urinary retention. This can happen when pressure from surgical instruments causes irritation or injury, making it harder for urine to pass. According to the University Urology Associates of New Jersey, this complication may be more common in males, who typically have longer urethras that pass through the prostate. Inflammation near the bladder neck or prostate can block the flow of urine.

In some cases, urinary retention can develop several weeks or months after a TURBT. Urinary retention can happen if scar tissue forms as a result of irritation from the surgical instruments. The scar tissue can narrow the urethra, making it more difficult to pass urine.

Urinary retention can develop weeks or months after a TURBT due to scar tissue. Let your doctor know if you can't urinate, or can only urinate a small amount.

Symptoms of urinary retention may include:

• Feeling like you can’t urinate at all
• Being able to pass only small amounts of urine
• Having pain or pressure in the lower abdomen

Urinary retention needs immediate medical attention. You should contact your urologist right away if you have any of the symptoms listed above. Treatment usually involves inserting a catheter to drain the bladder or flush out the clots. Without treatment, urinary retention can lead to kidney damage.

4. Bladder Perforation

Bladder perforation can occur if a surgical instrument cuts too deeply and makes a hole in the bladder wall. A 2023 study at one urology institute found that 10 percent of people who had a TURBT experienced bladder perforation. People who’ve had previous surgery for the treatment of bladder cancer may have a higher risk of bladder perforation.

Most bladder perforations cause mild symptoms or no symptoms at all and can heal on their own. In this case, a healthcare provider may leave the catheter in for a few additional days while a person heals.

A larger bladder perforation can cause urine to leak into the surrounding tissues. If this occurs, a surgeon may place a drainage tube in a person’s abdomen for a few days.

Although this complication sounds alarming, research shows that bladder perforation doesn’t increase the risk that bladder cancer advances or comes back. It also doesn’t increase the risk of needing a radical cystectomy (bladder removal surgery) in the future.

5. Anesthesia-Related Complications

TURBT is done under general or spinal anesthesia to prevent pain during the procedure. General anesthesia or spinal anesthesia is necessary for TURBT because the surgeon is working inside your bladder with delicate instruments. Without anesthesia, this procedure would be painful.

General anesthesia is considered safe, and the vast majority of people don’t have serious TURBT complications of anesthesia. However, there are still some associated postoperative risks, including:

• Confusion
• Pneumonia
• Stroke
• Heart attack

Serious complications of general anesthesia, such as heart attack or stroke, are rare and usually related to underlying health conditions. Studies show that fewer than 1 percent of people develop these complications after a TURBT. The complication rate associated with anesthesia may be higher for older adults and people with other medical conditions. Before a TURBT procedure, your oncology team will review your medical history and run tests to help reduce your risk of complications.

Less than 1 percent of people develop complications related to general anesthesia during a TURBT.

Spinal anesthesia is also very safe, but some side effects are possible, including:

• Backache
• Headache
• Nausea

When To Contact Your Healthcare Provider

After a transurethral resection of the bladder, it’s normal to have some side effects. For most people, side effects like painful urination or spots of blood in your urine get better within a few days or weeks. You should contact your healthcare provider if your symptoms don’t improve. For example, having blood in your urine two months after TURBT could indicate a more serious complication.

Other signs of possible TURBT complications include:

• Inability to urinate
• Ongoing pain during urination
• Large blood clots in the urine
• Fever
• Nausea or vomiting

Contact your healthcare provider right away if you develop these symptoms. They will likely recommend a follow-up appointment to check on your recovery.

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