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

Authors

  • 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.

DOI:

https://doi.org/10.5489/cuaj.7539

Keywords:

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

Abstract

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.

Downloads

Download data is not yet available.

Downloads

Published

2021-12-21

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

Issue

Vol. 16 No. 5 (2022): CUAJ May

Section

Review

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.