title: En Bloc Transurethral Resection of Bladder Tumors: A New Standard?
abstract: OBJECTIVE
  To assess safety and efficacy, namely pathological assessment of the specimen and recurrence rate, of en bloc transurethral resection (EBTUR) of bladder tumor.
  
  
  METHODS
  We performed a systematic review of the available literature on PubMed. Seventeen articles, mainly prospective case series, were found. EBTUR is performed with a great variety of equipments, whereas the resection technique is similar.
  
  
  RESULTS
  Overall, 895 patients have been submitted to EBTUR, accounting for 1191 lesions. Forty complications (4%) were computed. Only 10 (1%) were grade III, mostly bladder perforation or bleeding. Fifty-nine conversions (6.5%) to conventional transurethral resection (TUR) have been reported because of difficult locations of tumors or failure to extract the specimen. Several series, accounting for 763 patients, report about incidence of detrusor muscle in the specimen. Overall, 731 (96%) cases with detrusor muscle were computed. Tumor stage remained uncertain only in 12 (1.5%) cases. Follow-up data were available for 544 patients. Mean follow-up ranged from 9.3 to 40 months. Recurrence rate varied from 6% to 55%. Most of the recurrence occurred outside primary tumor site. Mean weighted follow-up across all series was 20 months, whereas overall recurrence rate was 23%.
  
  
  CONCLUSIONS
  Irrespective of the technique adopted, EBTUR is a safe procedure. The presence of detrusor muscle in the specimen is high if compared with historical series of conventional TUR. Indeed, recurrence rate is comparable. The objective advantage of a proper histological assessment suggests to perform EBTUR instead of conventional TUR, when feasible.
authors.affiliation: 1 Department of Urology, Ospedale San Giuseppe, Gruppo Multimedica , Milan, Italy .
authors.forename: Angelo
authors.initials: A
authors.lastname: Naselli
authors.affiliation: 2 Department of Urology, Istituti Clinici di Pavia e Vigevano - Gruppo San Donato , Pavia, Italy .
authors.forename: Paolo
authors.initials: P
authors.lastname: Puppo
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009130:Muscle, Smooth / Q000473:pathology; D057605:Natural Orifice Endoscopic Surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: bladder; bladder neoplasms; carcinoma; histology; transitional cell