Endoscopic treatment with transurethral resection of bladder tumor (TURBT) is the first-line treatment to diagnose, stage, and treat visible tumors. In select patients, office-based fulguration of small tumors allows control of low-risk lesions without incurring the cost and inefficiencies of the operating room. ^[1]

TURBT is not effective for carcinoma in situ (CIS) because the disease is often so diffuse and difficult to visualize that surgical removal is not feasible. Therefore, the role of cystoscopy is to establish the diagnosis so that therapy can be instituted. Obvious areas of CIS may also be fulgurated, but the benefits of this have not been proven. When a combination of papillary tumor and CIS is present, the papillary tumor is removed before treatment of the CIS is initiated.