En bloc transurethral resection of bladder tumors: A review of current techniques


  • Stefanie M. Croghan Department of Urology, University Hospital Waterford https://orcid.org/0000-0003-4524-3682
  • Niall Compton Department of Urology, University Hospital Waterford
  • Rustom P. Manecksha Department of Urology, St. James's Hospital Dublin. Department of Surgery, Trinity College Dublin.
  • Ivor M. Cullen Department of Urology, University Hospital Waterford
  • Pádraig J. Daly Department of Urology, University Hospital Waterford. Royal College of Surgeons, Ireland.




En Bloc; ERBT; Bladder Tumour; Endoscopic Resection; Bladder Cancer; Laser


Introduction: Growing interest surrounds the concept of en bloc transurethral resection of bladder tumors (ERBT). Theoretical advantages include improved adherence to oncological principles and potential yield of superior pathological specimens. Multiple ERBT methods exist. This review summarizes the current evidence regarding application of differing techniques and technologies to ERBT.

Methods: A systematic review of MEDLINE/EMBASE/Scopus databases was performed, using terms “en bloc,” “ERBT,” “bladder,” and “urinary bladder neoplasm.” Template-based data extraction included technique of ERBT, feasibility, tumor size, activation of obturator nerve reflex, operative complications, detrusor muscle sampling rate, and recurrence data.

Results: Multiple approaches to ERBT have evolved, using a variety of energy sources. The feasibility of electrocautery, laser, combined waterjet/electrocautery, and polypectomy snare techniques have been confirmed in achieving ERBT. ERBT appears safe, with a low complication rate. The use of laser energy sources reduces the risk of activating the obturator nerve reflex during lateral wall resections. Otherwise, no energy source is unequivocally superior in achieving ERBT. The rate of detrusor muscle sampling is high with use of ERBT and appears superior to that achieved with conventional TURBT (cTURBT) in multiple comparative studies. A limited number of largely non-randomized trials assess bladder tumor recurrence; current evidence suggests this is similar between ERBT and cTURBT groups.

Conclusions: ERBT using a variety of technologies is feasible and safe, with a high detrusor muscle sampling rate. Further research is required to determine whether rates of residual disease or recurrence can be reduced with ERBT vs. cTURBT.


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How to Cite

Croghan, S. M., Compton, N., Manecksha, R. P., Cullen, I. M., & Daly, P. J. (2021). En bloc transurethral resection of bladder tumors: A review of current techniques. Canadian Urological Association Journal, 16(5), E287–93. https://doi.org/10.5489/cuaj.7539