Transurethral resection of bladder tumor (TURBT) is a minimally invasive procedure that has a lot going for it. It’s similar to colonoscopy, in that a long, thin tube is inserted through a natural opening – in this case, the urethra – and if a tumor is found, it can be diagnosed and removed during the same procedure. TURBT is minimally invasive, typically done in an outpatient setting, often described as “routine, incision-free, and well-tolerated.” 

Room for Improvement

But urologist Max Kates, M.D., the R. Christian B. Evensen Professor, Director of Urologic Oncology at the Brady, and Co-Director of the Greenberg Bladder Cancer Institute, heard otherwise from his patients – many of whom reported that they experienced significant distress and discomfort after the procedure. 

In 2023, Kates and his urologic oncology fellow Michael Rezaee, M.D., M.P.H., led a study involving 159 patients at multiple centers to characterize the side effects from TURBT and recovery from the procedure. “That study revealed that up to a third of patients suffer notable symptoms like painful or uncomfortable urination, penile or vaginal pain, suprapubic pain, and urinary urgency and frequency,” plus constipation and lack of sleep. Ten percent of patients needed an urgent visit to the clinic or Emergency Department, and about 7 percent had to be admitted to the hospital. Female patients, diabetic patients, and those with more advanced tumors were especially at risk for a harder recovery. 

Determined to make TURBT better, Kates and Rezaee – along with guidance from patients and their clinicians – designed a new “Enhanced Recovery After Surgery” (ERAS) protocol, which targets factors of delayed recovery – the pain, the urinary urgency and frequency, and the slow return of normal bowel and urinary function. 

The new protocol was tested recently in a clinical trial called EMBRACE; 100 patients were randomly assigned either to receive standard care or the ERAS approach. Patients in the ERAS group received improved education, tailored pain management, and structured follow-up. “The results were clear,” says Kates. “Patients in the ERAS group felt significantly better, reporting higher quality of recovery, less pain, fewer urinary issues, and less incontinence the day after surgery.” 

“With the ERAS protocol, we can provide more empathy, structure, and support to care for our patients with bladder cancer.” 

In addition to Kates and Rezaee, investigators on this study include Katherine Mahon, M.D., Bruce Trock, Ph.D., The-Hung Edward Nguyen, M.D., Armine Smith, M.D., Noah Hahn, M.D., and Sunil Patel, M.D., M.A.