According to current guidelines, the surgical treatment of benign prostatic hyperplasia is the main therapeutic option, being refractory to conservative approach. Transurethral resection of the prostate and open transvesical adenomectomy have been considered a reference standard in the treatment of medium (<80ml) and large (> 80ml) benign prostatic hyperplasia. To reduce postoperative complications and promote faster postoperative recovery, there have been proposed several minimally invasive techniques for the treatment of large benign prostatic hyperplasia, the most innovative being laser surgery. Lasers used in retrograde transurethral endoscopic vapoenucleation of the prostate has become a new concept in transurethral surgery. This surgical approach provides promising results and is becoming increasingly popular for the management of severe lower urinary tract symptoms secondary to large benign prostatic hyperplasia.
Transurethral resection is very important not only for diagnosis and treatment of NMIBC, but also for its management. The application field of transurethral resection includes establishing histological diagnosis, determination of prognostic factors including the tumor stage, complete resection of all detected tumors of urinary bladder. Transurethral resection of bladder tumor (TURBT) is the standard technique for the diagnosis and treatment of non-muscle invasive bladder cancer. This method has also some limitations. One of the limitations is the insufficient assessment of the resection depth. It leads to the necessity of intravesical tumor fragmentation, but its disadvantage is that it limits the histopathological evaluation. In order to improve the treatment outcome for patients with non-muscular invasive bladder tumors, several new techniques such as En-bloc resection were proposed.
Background: Transurethral resection of the bladder (TURB) tumor was first described by Stern and McCarthy in 1931, and is still considered the gold standard in diagnosis and treatment of non-muscle-invasive bladder cancer. The quality of TURB affects accuracy of histopathologic evaluation, and subsequently impacts the risk of recurrence and patient outcome. New methods that aim to improve the effectiveness of TURB are reviewed, and recent studies are discussed, including resection methods and image enhancement techniques. Material and methods: Between January 2016 and April 2019, within the Urology Clinic of Nicolae Testemitanu State University of Medicine and Pharmacy 108 patients were surgically treated with bladder tumor pathology. Patients were divided in two groups: En-bloc resection group which includes 51 patients and transurethral resection group with 57 patients, the obtained data were comparatively analyzed. Results: Tumor analysis showed that the majority of the patients’ tumors were localized on lateral urinary bladder walls, single bladder tumors were detected in 64 (59%) cases, tumor sizes up to 3 cm were detected in 74 (69%) patients included in the study. Detrusor muscles were detected in 49 (96%) cases of En-bloc group and 45 (79%) cases of TURB group. Most recurrences occurred in patients with high-grade histological result, recurrence rate in En-bloc group occurred in 18% and in TURB group in 37%. Conclusions: The En-bloc resection technique of non-muscle-invasive bladder tumor proved to be a safe and effective method compared to the conventional transurethral resection technique (TURB). This method provides more favorable results for obtaining better quality tumor samples (present of detrusor muscle) that allow to establish correct diagnosis and staging of the disease and reduces the number of recurrences.
Résection endoscopique répétée du cancer de la vessie non-infiltrant le muscleIntroduction. Les exigences de traitement pour le cancer de la vessie non-infiltrant le muscle (Ta, T1) et la maladie de la vessie avec l'invasion de la paroi musculaire (T2) diffèrent considérablement, par conséquent, une stadification correcte de la maladie est très importante. Le stade de la maladie est souvent sous-estimé au cours de la résection primaire de la tumeur. L'objectif de l'étude: évaluer les résultats des résections transurétrales répétées des tumeurs de la vessie afin d'évaluer les résultats du traitement. Méthodes. 160 de patients diagnostiqués avec le cancer de la vessie non-infiltrant le muscle ont subi une résection endoscopique de tumeur de vessie (RTUTV) et une résection endoscopique de tumeur de vessie répétée (reRTUTV). On a effectué l'analyse des données des interventions du patient, l'examen histopathologique, la stadification de la maladie et l'évaluation dynamique pendant le temps d'un suivi d'un an. Résultats. L'âge moyen des patients était de 65,7 ans (intervalle de 28 à 86 ans) et la majorité des patients étaient de sexe masculin 139 (87%). Dans la majorité
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