Improving Transurethral Resection of Bladder Tumour: The Gold Standard for Diagnosis and Treatment of Bladder Tumours

Transurethral resection of bladder tumour (TURB) remains the gold standard for management of bladder cancer, but there is evidence of a high rate of tumour recurrence after primary resection, and of variation between institutions. Surgical accuracy is paramount to the safety and efficacy of TURB, but technical and procedural considerations may also have an impact on outcomes. A second resection may improve staging and tumour removal, particularly where the primary procedure was affected by multiple tumours, large tumour bulk, bleeding during resection, bladder perforation, patient habitus, or anaesthetic risk, or if the patient has high-risk bladder tumour, T1 tumour, multiple high-grade Ta tumours, or carcinoma in situ. The piecemeal resection achieved by standard TURB may contribute to tumour recurrence, and technical modifications are being developed to provide en bloc tumour resection. The authors are refining an en bloc method using a knife electrode. Modifications to the resectoscope are also under investigation, and there are encouraging results from studies of alternative energy sources. These modifications of TURB equipment and techniques offer exciting possibilities for improving outcomes in bladder cancer. A move towards en bloc rather than piecemeal resection may help to reduce recurrence rates. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.