Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer.
BACKGROUND
Despite today's standard procedure for staging and treating non-muscle-invasive bladder cancer by transurethral resection via a wire loop (TURBT), several other publications have dealt with a different concept of en bloc resection of bladder tumors using different energy sources.


METHODS
MEDLINE and the Cochrane central register were searched for the following terms: en bloc, mucosectomy, laser, resection, ablation, Neodym, Holmium, Thulium, transitional cell carcinoma.


RESULTS
Fourteen research articles dealing with en bloc resection of non-muscle-invasive bladder cancer could be identified (modified resection loops: six, laser: six, waterjet hydrodissection: two).


CONCLUSIONS
En bloc resection of bladder tumors >1 cm can be performed safely with very low complication rates independent of the power source. By using laser, complication rates might even be decreased, based on their good hemostatic effect and by avoiding the obturator nerve reflex. A further advantage seems to be accurate pathologic staging of en bloc tumors. Randomized controlled trials are still needed to support the assumed advantages of en bloc resection over the standard TURBT with regard to primary targets: First-time clearance of disease, accurate staging and recurrence rates.
Department of Urology and Urologic Oncology, Hannover Medical School (MHH) , Hannover , Germany.
Mario W
MW
Kramer
Islam F
IF
Abdelkawi
Mathias
M
Wolters
Thorsten
T
Bach
Andreas J
AJ
Gross
Udo
U
Nagele
Pierre
P
Conort
Axel S
AS
Merseburger
Markus A
MA
Kuczyk
Thomas R W
TR
Herrmann
D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
Laser; TURB; bladder cancer; en bloc; transitional cell carcinoma