A novel transurethral resection technique for superficial bladder tumor: retrograde en bloc resection

Abstract

Background: Transurethral resection of bladder tumor (TURBT) is the standard approach to bladder tumors but suffers from several disadvantages. The aim of this study was to evaluate the safety and efficacy of a novel procedure of retrograde en bloc resection of bladder tumor (RERBT) with conventional monopolar resection electrode for the treatment of superficial bladder tumors.

Methods: RERBT and conventional TURBT (C-TURBT) were conducted, respectively, in 40 and 50 patients diagnosed with superficial papillary bladder tumors. In the RERBT group, the tumors were en bloc removed retrogradely under direct vision using a conventional monopolar electrode. Patients' clinicopathological, intraoperative, and postoperative data were compared retrospectively between the RERBT and C-TURBT groups.

Results: Of the 90 patients, 40 underwent RERBT and 50 underwent C-TURBT. Both groups were comparable in clinicopathological characteristic. RERBT could be performed as safely and effectively as C-TURBT. There were no significant differences in operative time and surgical complications. The cumulative recurrence rates between groups were similar during up to 18 months follow-up. The detrusor muscle could be identified pathologically in 100% of RERBT tumor specimens and the biopsy of tumor bases, but only in 54 and 70%, respectively, of C-TURBT samples (P < 0.01).

Conclusions: The RERBT technique is feasible and safe for superficial bladder tumors using conventional monopolar resection setting, with the advantages of adequate tumor resection and the ability to collect good quality tumor specimens for pathological diagnosis and staging compared to conventional TURBT.

Keywords: En-bloc resection; Non-muscle-invasive bladder cancer; Transurethral resection of bladder tumor.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Xiamen University Affiliated First Hospital.

Consent for publication

All patients enrolled in the study signed the consent for publication.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

a A 1.5-cm-diameter bladder tumor on the right bladder wall. b Macroscopic normal mucosa about 0.5 cm away from the tumor base was margined. Then, the bladder mucosa was subsequently cut in a “flash-firing” fashion. c After the deep muscle layer was reached when normal glistening yellow fat is seen between muscle layers, the loop was moved forward along the muscle layer. d The tumor was resected in one piece

Fig. 2

Histologic findings of resected tumors. a The lamina propria mucosa was severely charred without muscular propria in a tumor in the C-TURBT group (×40). b The lamina propria mucosae remained intact, and the muscular propria was identified in a tumor in the RERBT group (×40)