Surgical implications of TURBT in an aging bladder cancer population

Etan Eigner^1,2, Nicola Fazaa^1,2, Ameer Nsair^1,2, Melissa Atallah^1,2, Gilad E. Amiel^1,2, Azik Hoffman^1,2, Kamil Malshy^3,*
1 Rappaport Faculty of Medicine, Technion, Haifa, Israel
2 The Department of Urology, Rambam Health Care Campus, Haifa, Israel
3 Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
* Corresponding Author: Kamil Malshy. Email: email
(This article belongs to the Special Issue: Bladder and Prostate Cancers and Clinical Trials in Urologic Oncology)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.079599

Received 24 January 2026; Accepted 29 May 2026; Published online 01 July 2026

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Abstract

Bladder cancer predominantly affects older adults, and transurethral resection of bladder tumor (TURBT) remains the cornerstone of diagnosis and management for non–muscle-invasive disease. As the bladder cancer population ages, TURBT is increasingly performed in patients with frailty, multimorbidity, and limited physiologic reserve. Although often framed as a routine procedure, the cumulative clinical implications of TURBT in elderly patients are increasingly recognized. The objective of this narrative review is to critically evaluate the perioperative, functional, psychosocial, and economic consequences of TURBT in older adults, with particular emphasis on frailty as a determinant of outcomes and on the cumulative burden of repeated interventions. We conducted a narrative review of contemporary literature evaluating perioperative, functional, psychosocial, and economic outcomes of TURBT in older adults. Emphasis was placed on real-world complication data, frailty as a modifier of surgical risk, and downstream consequences beyond traditional surgical endpoints. Emerging non-surgical and office-based alternatives were also reviewed to contextualize evolving management strategies.
Available population-based and registry data demonstrate that complications following TURBT are common in elderly patients, including bleeding, urinary retention, delirium, and unplanned hospitalization. These events frequently precipitate cascading morbidity, such as functional decline, cognitive deterioration, caregiver burden, and financial toxicity. Frailty consistently predicts adverse outcomes more accurately than chronological age. Repeated TURBT in frail patients with indolent disease may offer diminishing clinical benefit, particularly in the setting of substantial competing mortality risks. Taken together, these findings suggest that in an aging bladder cancer population, TURBT carries clinically meaningful risks that extend beyond traditional perioperative complications. Incorporating frailty-aware risk stratification and patient-centered outcomes into clinical decision-making may help better align treatment intensity with patient vulnerability and goals of care.