Difference between detrusor muscle presence and thermal tissue damage in bladder cancer specimens according to resection technique: Monopolar vs bipolar

2015 ◽  
Vol 14 (6) ◽  
pp. e1335
Author(s):  
K. Krpina ◽  
M. Materljan ◽  
S. Mesarov ◽  
J. Španjol ◽  
D. Markić
Keyword(s):  
Bladder Cancer ◽  
Tissue Damage ◽  
Detrusor Muscle ◽  
Thermal Tissue Damage

EN BLOC RESECTION OF BLADDER TUMOR(EBRT) USING MONOPOLAR CAUTERY; A TERTIARY HOSPITAL EXPERIENCE.

2021 ◽  
pp. 15-16
Author(s):  
Neeraj Agarwal ◽  
Bhuwan kumar ◽  
Prashant Gupta ◽  
Govind Sharma ◽  
Shivam Priyadarshi
Keyword(s):  
Bladder Cancer ◽  
Correct Diagnosis ◽  
En Bloc Resection ◽  
Tertiary Hospital ◽  
Complete Resection ◽  
High Rate ◽  
Severe Bleeding ◽  
Detrusor Muscle ◽  
Bladder Tumors ◽  
En Bloc

Bladder cancer is a growing health problem with the second most common urological malignancy. It accounts for around 7% of a new cancer diagnosis. Tobacco smoking is the most important risk factor accounting for around 50% of cases. Tobacco smokes contain aromatic amines and polycyclic hydrocarbons which are excreted through kidneys. The goal of transurethral biopsy in NMIBC(non-muscle invasive bladder cancer) is to make the correct diagnosis and completely remove all visible lesions which can be either resected piecemeal or en bloc. The presence of detrusor muscle in the specimen is an important factor for planning treatment and prognosis. Here we share our experience of EBRT using monopolar cautery describing the feasibility, safety, and adequacy of the procedure in the management of small urinary bladder tumors. The study was conducted in the Department of Urology, SMS Medical College, and attached hospitals. All the patients with clinical NMIBC during study duration were admitted and a total of 25 patients above the age of 18yrs, having papillary bladder tumors less than 3 cm were included in the study. Complete resection by the en bloc technique was achieved in all 25 cases with no requirement of conversion to conventional TURBT. Our study also shows the presence of detrusor muscle in 22 specimens out of 25. And only two patients developed severe bleeding which needed a blood transfusion. Thus, ERBT using monopolar cautery is safe and feasible for the complete resection of NMIBCs with a high rate of detrusor-positive specimens in the selected patient population.

How well do we manage non-muscle invasive bladder tumors? A UK audit of real-life practices

2020 ◽  
Vol 87 (3) ◽  
pp. 142-148
Author(s):  
Petros Sountoulides ◽  
Wilbert Fana Mutomba ◽  
Emmanouil Bouras ◽  
Jieqi Lim ◽  
Andreas Bourdoumis ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Carcinoma In Situ ◽  
Real Life ◽  
Invasive Bladder Cancer ◽  
Detrusor Muscle ◽  
Bladder Tumors ◽  
Recurrence Rates ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Objective: The aim of this study was to assess the quality of TURBT (transurethral resection of bladder tumor) using surrogate parameters and evaluate adherence to the guidelines regarding the management of bladder tumors. Materials and methods: A clinical audit of all new diagnosis of bladder cancer was undertaken from January 2016 to January 2017. A total of 101 new bladder cancer cases were included. Surrogates of TURBT quality including presence of detrusor in the specimen, rate of re-TUR, presence of carcinoma in situ, and 3-month recurrence rates were analyzed. Adherence to guidelines regarding management of non-muscle invasive bladder cancer including time to re-TUR and utilization of single instillation chemotherapy was evaluated. Results: Absence of detrusor muscle in the specimen of the initial TURBT was noted in 22.8% of the cases. The chance of including muscle in the specimen was almost four-fold for tumors larger than 3 cm. A single instillation of intravesical chemotherapy following TURBT was administered in only 40% of eligible patients; 54.3% of patients had a re-TUR, the majority (61.3%) for high-grade non-muscle invasive bladder cancer on initial TURBT. Re-TUR was done on average 10 weeks after initial TURBT. The 3-month recurrence rate was 36.0% with larger tumors (>3 cm) being more prone to early recurrences. Early recurrences were not affected by intravesical instillations with bacillus Calmette–Guérin or mitomycin C although there was a positive association between the presence of carcinoma in situ on initial resection and early recurrences. Discussion and conclusion: One in two patients will have a re-TUR, and approximately one in two patients will have tumor on re-TUR. Single immediate chemotherapy instillations after TURBT are underutilized. The presence of carcinoma in situ on initial TURBT and tumor size were predictors of early recurrences.

Two-step transurethral resection of bladder tumor can result in a better surgical quality and lower recurrence in patients with non-muscle invasive bladder cancer: a retrospective study

2020 ◽  
Author(s):  
Wei-Lun Huang ◽  
Chao-Yuan Huang ◽  
Kuo-How Huang ◽  
Yeong-Shiau Pu ◽  
Hong-Chiang Chang ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Sampling Rate ◽  
Invasive Bladder Cancer ◽  
Detrusor Muscle ◽  
Muscle Invasive Bladder Cancer ◽  
Free Survival ◽  
Muscle Invasive

Abstract Background Current protocols for transurethral resection of bladder tumor (TURBT) are still unstandardized, and outcomes are also uneven in different protocols. In our medical center, we performed two-step TURBT that the resection of bladder tumor is made in two steps- exophytic parts first and tumor bases second. The purpose is to improve tumor eradication and increase detrusor muscle sampling rates. The aim of current study is to evaluate clinical outcomes and detrusor muscle sampling rate of two-step TURBT in patients with non-muscle invasive bladder cancer (NMIBC). Methods We conducted a retrospective review from a prospective database. From January 2012 to December 2017, patients who had newly diagnosed NMIBC with a follow-up period of more than 2 years were enrolled. Patients with concomitant or subsequent upper urinary tract urothelial carcinoma (UTUC) were excluded. Patients were categorized into the two-step TURBT (TR) and the conventional TURBT (CR) groups. The primary endpoints were recurrence and progression rates. The secondary endpoints were recurrence-free survival (RFS), progression-free survival (PFS), and the detrusor muscle sampling rate. Results There were 205 patients included in our study, with 151 patients in the TR group and 54 patients in the CR group. The median follow-up period was 40.5 months. There were lower recurrence rate ( P = 0.015), higher detrusor muscle sampling rate ( P = 0.043), and better RFS (Log-Rank P= 0.007) in the TR group. Two-step TURBT was also associated with better RFS in both univariate ( P =0.009) and multivariate ( P =0.003) Cox proportional hazards regression. Conclusions In patients with NMIBC, Two-step TURBT results in higher detrusor muscle sampling rate and better disease outcomes. The findings suggest that Two-step TURBT is a better surgical method for treating NMIBC.

Closed-loop audit of muscle sampling in Trans-Urethral Resection of Bladder Tumour

2021 ◽  
pp. 205141582110499
Author(s):  
Raghav Varma ◽  
Abdalla Deb ◽  
Dorina Roy ◽  
Ali Ahmed
Keyword(s):  
Bladder Cancer ◽  
Closed Loop ◽  
Bladder Tumour ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Detrusor Muscle ◽  
En Bloc ◽  
Level Of Evidence ◽  
Muscle Invasive

Introduction: Our experience with the presence of detrusor muscle (DM) following Trans-Urethral Resection of Bladder Tumour (TURBT). Objectives: To evaluate the presence of DM in primary TURBT specimens as a quality improvement exercise in Frimley Park Hospital, UK. And to assess if the level of the surgeon has impact on outcomes. Methods: Retrospective and prospective analysis of the electronic records from a single urology centre, servicing a group of urologists. Data collected over three consecutive audit loops between January 2014 and May 2018. Results: A total of 301 cases were performed under the care of seven consultant urologists. Analysis revealed a significant improvement in the overall quality of resections from 39% to 66% (50–84% for intermediate and high grade) after the introduction of the following interventions: (1) analysis and improved awareness of current practice; (2) introduction of European Association of Urology (EAU) guidelines by separating samples and sending a second specimen pot marked as bladder tumour base to look for DM; (3) dedicated urologists with an interest in bladder cancer performing en-bloc resection technique in appropriate cases. Conclusion: Through our closed-loop audits, we have demonstrated a considerable improvement in the quality of resections, resulting in accurate staging from the initial resection. This could in turn lead to improved over all prognoses and negating the need for re-resection in all cases of high-risk non-muscle invasive bladder cancer (NMIBC). Level of evidence: 3

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