Characterizing Symptoms and Defining Toxicity in Ambulatory TURBT: Results from a Multicenter Prospective Cohort Study

Michael E Rezaee; Katherine M Mahon; Zhuo Tony Su; Kaylee M Luck; John D Seigne; Sunil H Patel; Max Kates

doi:10.1016/j.urology.2025.06.051

Characterizing Symptoms and Defining Toxicity in Ambulatory TURBT: Results from a Multicenter Prospective Cohort Study

Urology. 2025 Jun 26:S0090-4295(25)00632-6. doi: 10.1016/j.urology.2025.06.051. Online ahead of print.

Authors

Michael E Rezaee¹, Katherine M Mahon², Zhuo Tony Su², Kaylee M Luck³, John D Seigne³, Sunil H Patel², Max Kates⁴

Affiliations

¹ Concord Hospital Urologic Institute, 246 Pleasant Street, Concord, NH 03301.
² The Brady Urological Institute, Johns Hopkins Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287.
³ Section of Urology, Department of Surgery, One Medical Center Drive, Lebanon, NH, 03756.
⁴ The Brady Urological Institute, Johns Hopkins Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287. Electronic address: Mkates@jhmi.edu.

PMID: 40581221
DOI: 10.1016/j.urology.2025.06.051

Abstract

Objective: To characterize patient symptoms and toxicity associated with present-day ambulatory transurethral resection of bladder tumor (TURBT) METHODS: A multicenter prospective cohort study of participants with bladder cancer undergoing TURBT was performed from January 2023 to August 2023. Visual analog scale (VAS) pain scores and open-ended feedback responses were collected preoperatively, immediately postop, 6-10 hours, 2-3 days, and 7-9 days after surgery. Linear mixed-effects modeling with random intercepts to account for repeated measures was used to assess the relationship between patient characteristics and study outcomes.

Results: 159 patients underwent TURBT during the study period. Most patients were undergoing a TURBT for the first time (46.5%), were male (77.4%), and had a median age of 71 years. Mean suprapubic pain, dysuria, and penile or vaginal pain among patients in the third tertile of symptom burden was 5.6, 2.4, and 2.4 times higher than patients in the seconder tertile, respectively. Most patients experienced post procedural hematuria (79.3%), while a third of patients experienced bladder spasms and incontinence. Issues with constipation were self-reported by 24.7% of patients, while 19.7% and 6.8% struggled with lack of sleep and depression/anxiety. An unplanned emergency room (ED) or clinic visit occurred in 10.1% of patients. After adjustment, female sex (β 0.96, 95% CI [0.47, 1.45]) and having stage ≥ T2 bladder cancer on final pathology (β 1.04, 95% CI [0.32, 1.76]) were significantly associated with greater suprapubic pain during the study period. A Foley catheter at discharge (β -1.36, 95% CI [-1.86, - 0.87]) and increasing patient age (β -0.02, 95% CI [-0.05, -0.002]) were inversely associated with dysuria.

Conclusion: The degree of distress and discomfort experienced by some patients after TURBT is likely underappreciated. To embrace a model of survivorship in bladder cancer care, symptom reduction and quality of recovery after TURBT must be optimized.