Bladder cancer: new TUR techniques

Abstract

Transurethral resection of bladder tumours (TURBT) using a wire loop remains the gold-standard treatment for bladder tumours, but it is associated with unacceptably high early recurrence rates after first resection. Improvements to standard resection techniques and a range of optical and technological advances offer exciting possibilities for improving outcomes. Early second resection has been shown to reduce recurrence rates, and increase response to intravesical chemotherapy and/or immunotherapy. It should be considered in most high-risk non-muscle invasive cancers (T1; G3; multifocal) being managed by bladder conservation. Newer energy sources, such as laser, may facilitate day case management of bladder tumours using local anaesthesia in select groups of patients. The novel technique of photodynamic diagnosis improves tumour detection, and quality of resection, and is likely to become the standard for initial tumour management. The traditional 'incise and scatter' resection technique goes against all oncological surgical principles. En-bloc resection of tumours would be far preferable and demands further development and evaluation. The technique of TURBT needs to evolve to allow first-time clearance of disease and low recurrence rates.

Improvement of Tumor Localization of Photosensitizers for Photodynamic Therapy and Its Application for Tumor Diagnosis

“…In treating nonmuscle-invasive bladder cancer (NMIBC), a form of endoscopic surgery named transurethral resection of the bladder tumor (TURBT) using cytoscopy has contributed to functional preservation [61]. While a less-invasive approach of TURBT enhances patient quality of life, high (25-70%) disease recurrence rate is reported for patients with NMIBC [62,63].…”

Design and Performance Evaluation of a Minimally Invasive Telerobotic Platform for Transurethral Surveillance and Intervention

“…The anatomic constraints of the entrance through the urethra make access to anterior regions of the bladder difficult or infeasible without external manipulation. Wilby et al [5] have attributed instrumentation as a significant limitation influencing resection quality.…”

“…Despite the significant literature and clinical history of the TUR procedure in treatment of bladder cancer, outcomes are variable and highly dependent on the experience and technical ability of the urologic surgeon. The limitations of the current instrumentation play a critical role in the ability of surgeons to deliver consistent care [5].…”

Transurethrale En-bloc-Resektion nicht muskelinvasiver Harnblasenkarzinome

“…Hierbei handelt es sich um eine "Incise-und-scatter-Technik", die gerade bei Tumoren, die eine Schlingenbreite über-schreiten zu deren Fragmentierung führt und im Verdacht steht über Zellstreuung an Rezidiven außerhalb des Resektionsareals beteiligt zu sein [7,8]. Die Sorgfältigkeit der initialen TURB ist u. a. entscheidend für die weitere Prognose eines Patienten [9].…”