Transurethral Resection of Bladder Cancer (TUR-B) for Non-Muscle Invasive Bladder Cancer: How to Reach Excellence?

Transurethral resection of bladder cancer (TUR-B) is the primary surgical method for the diagnosis, staging and treatment of primary or recurrent non-muscle-invasive bladder cancer. For this reason, reaching a level of excellence is of upmost importance. In this review, we aimed to summarize important points and technological developments to maintain successful TUR-B. Resection of smaller tumors should be made en bloc and for larger tuomors, resection should start from the outer portion and the base of the tumor should be resected thereafter together with the underlying muscle layer. In bipolar systems, the electrocautery circuit is completed through the resection loop in contrast to that in monopolar systems. This maintains lower rates of obturator reflex. Both techniques are similar in terms of efficacy and complications. Laser ablation of bladder cancer can be made under local anesthesia. Obturator nerve reflex is not observed and bleeding is also rare. It has been suggested that white light cystoscopy is not precise enough to detect flat highgrade lesions and lateral borders of the tumors. For this reason, new imaging methods have been established. These methods can be listed as follows: photodynamic diagnosis, narrow band imaging, confocal laser endomicroscopy and optical coherence tomography. TUR-B is the most important step in diagnosis, staging and treatment of bladder cancer. Best practice of TUR-B will aid in deciding appropriate adjuvant treatment and for certain stages and decreasing recurrence and progression rates. For this reason, the importance of improving the techniques of TUR-B and the importance of adequate training programmes is obvious. Besides, to increase efficacy, devopment of energy sources and imaging modalities is mandatory.