Approaching the optimal transurethral resection of a bladder tumor

Abstract

A complete transurethral resection of a bladder tumor (TURBT) is essential for adequately diagnosing, staging, and treating bladder cancer. A TURBT is deceptively difficult and is a highly underappreciated procedure. An incomplete resection is the major reason for the high incidence of recurrence following initial transurethral resection and thus to the suboptimal care of our patients. Our objective was to review the preoperative, intraoperative, and postoperative considerations for performing an optimal TURBT. The European Association of Urology, Society of International Urology, and The American Urological Association guidelines emphasize a complete resection of all visible tumor during a TURBT. This review will emphasize the various techniques and treatments, including photodynamic cystoscopy, intravesical chemotherapy, and a perioperative checklist, that can be used to help to enable a complete resection and reduce the recurrence rate. A Medline/PubMed search was completed for original and review articles related to transurethral resection and the treatment of non-muscle-invasive bladder cancer. The major findings were analyzed and are presented from large prospective, retrospective, and review studies.

Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

“…Adequate resection must be performed for staging and for adequate treatment [16]. The complication rate increases during TURB due to the development of inappropriate surgical conditions not associated with the adductor muscle contraction, which results in inadequate resection and inadequate treatment [17].…”

To study the efficacy of Obturator Nerve blocks using nerve stimulator in Transurethral Resection of Bladder Tumor (TURBT) under spinal anaesthesia

“…About 9 out of 10 people with this cancer are over the age of 55 years. The average age at the time of diagnosis is 73 years and men are about 3 to 4 times more likely to get bladder cancer during their lifetime than women 7 . In this study the average age of patients are 65 years and 65% to 80% patients belong to ASA grade II.…”

A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer

“…The largest clinically important impact is on detection of CIS. 2 Use of these newer modalities was not undertaken in our study.…”

“…flatten the mucosa and make it more difficult to visualize areas of Carcinoma in situ (CIS). 2 Biopsies from normal-looking mucosa is recommended when cytology is positive or when high-risk exophytic tumor is present (sessile appearance). Additionally, prostatic urethra biopsies are to be taken in cases of bladder neck tumor, when bladder CIS is present, when there is positive cytology without evidence of tumors in the bladder, or when abnormalities of the prostatic urethra are visible.…”