Office-based transurethral resection of multiple bladder tumors using blue dye-mixed local anesthesia: a descriptive cohort study.
OBJECTIVE
Hospitalization and general anesthesia to perform transurethral resection of bladder tumors (BTs) may not be necessary for small recurrent BTs. We developed a new outpatient procedure.


METHODS
Patients with recurrent small tumors who had previously undergone transurethral resection of BTs for low-grade, noninvasive BTs were eligible for this new procedure. Between July 2005 and 2007, 21 surgeries were performed on 11 patients. The patients' mean age was 65.6 years. The bladder was dilated with CO(2) using a 15.5F flexible cystoscope. Blue dye-mixed local anesthetic (2% xylocaine:indigo carmine 8:2) was injected into the tumor base. The tumor was resected using electric current via a hot cup. Patients went home without an indwelling catheter if there was no hematuria in the first urination after the procedure.


RESULTS
Fifteen surgeries revealed one tumor, two had two tumors, two had three tumors, and two had six tumors. No complications requiring hospitalization occurred. Each resected specimen included a submucosal layer that allowed differentiation between pTa and pT1. No thermal degeneration was apparent in the resected stumps on pathological examination. Sixteen cases were urothelial carcinoma, and five cases were benign. Fifteen of the malignancies were noninvasive/low-grade tumors, but one case was microinvasive/high grade (G3pT1). During follow-up (mean, 8.8 months) recurrence in the bladder was found in 47%, but there was no orthotopic recurrence in the tumor-resected region.


CONCLUSIONS
Our method allows safe resection of multiple recurrent BTs on an outpatient basis. This approach is a promising method for pathological diagnosis and favorable local control.
Department of Urology, St. Luke's International Hospital, Tokyo, Japan. endofum@luke.or.jp
Fumiyasu
F
Endo
Yoshiyuki
Y
Shiga
Masahiro
M
Yashi
Kazunori
K
Hattori
Osamu
O
Muraishi
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000772:Anesthesia, Local; D015331:Cohort Studies; D004396:Coloring Agents / Q000008:administration & dosage*; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D014521:Urethra / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
D004396:Coloring Agents