Objective: To evaluate the impact of maximal transurethral resection of bladder tumor (TURBT) on perioperative outcomes following radical cystectomy (RC).

Methods: This study included 310 patients who underwent RC for the diagnosis of bladder urothelial carcinoma. Of these, 146 patients had a history of maximal TURBT (TURBT group) and 164 did not (non-TURBT group). Patients in the TURBT group were categorized into four groups according to the time interval between the last TURBT and RC: ≤ 1 month, 1-3 months, 3-6 months, and > 6 months. Additionally, the TURBT group was stratified into a single TURBT group and multiple TURBT group. Perioperative outcomes were compared between the groups.

Results: The median duration of pelvic drainage tube retention was longer in the TURBT group (11 vs. 9 days, p = 0.037). The incidence of Clavien-Dindo ≥ 3 complications (15.3% vs. 7.3%, p = 0.031) and ICU admission rate(10.4% vs. 4.5%, p = 0.048) were higher in the TURBT group. Statistically significant differences were observed in the incidence of Clavien-Dindo ≥ 3 complications (p = 0.007), reoperation rates (p = 0.041), incidence of sepsis (p = 0.022), and urinary complications (p = 0.024) across the four groups stratified by the time interval between TURBT and RC, with the 1-3 to months group demonstrating the highest incidence. There was no significant difference in perioperative outcomes between patients who underwent a single TURBT and those who underwent multiple TURBT.

Conclusions: Patients with a history of maximal TURBT, especially those who underwent RC within 1-3 months after maximal TURBT, have an increased risk of unfavorable perioperative outcomes following RC.