Approaching the optimal transurethral resection of a bladder tumor

Abstract

A complete transurethral resection of a bladder tumor (TURBT) is essential for adequately diagnosing, staging, and treating bladder cancer. A TURBT is deceptively diffcult and is a highly underappreciated procedure. An incomplete resection is the major reason for the high incidence of recurrence following ini- tial transurethral resection and thus to the suboptimal care of our patients. Our objective was to review the preoperative, intraoperative, and postoperative considerations for performing an optimal TURBT. The Eu- ropean Association of Urology, Society of International Urology, and The American Urological Association guidelines emphasize a complete resection of all visible tumor during a TURBT. This review will emphasize the various techniques and treatments, including photodynamic cystoscopy, intravesical chemotherapy, and a perioperative checklist, that can be used to help to enable a complete resection and reduce the recurrence rate. A Medline/PubMed search was completed for original and review articles related to transurethral re- section and the treatment of non-muscle-invasive bladder cancer. The major fndings were analyzed and are presented from large prospective, retrospective, and review studies.