World Journal of Urology

, Volume 37, Issue 12, pp 2677–2682 | Cite as

En bloc resection improves the identification of muscularis mucosae in non-muscle invasive bladder cancer

  • Hua Liang
  • Tao Yang
  • Kaijie Wu
  • Dalin HeEmail author
  • Jinhai FanEmail author
Original Article



The T1 substage, according to the relationship between muscularis mucosae (MM) and tumors, is a promising prognostic factor for T1 bladder cancer. However, the identification rate of MM is low in specimens, and it is, therefore, not widely used in clinical practice. In this study, we investigated whether en bloc resection of non-muscle invasive bladder cancer (NMIBC) could improve the identification of muscularis mucosae (MM), which may further accurate identification of the T1 substage.

Patients and methods

Specimens from 158 patients with primary NMIBC were retrospectively reviewed by two independent pathologists to assess the presence of MM and stratify the T1 substage. Of 158 specimens, 70 specimens were obtained via TURBt with a plasma kinetic loop and 88 were obtained via front-firing potassium-titanyl-phosphate (KTP) green-light laser en bloc resection. Univariable and multivariable logistic regression models were used to analyze the relationship between the clinical characteristics and the presence of MM.


The mean age was 58.22 years (range 18–85 years). Multivariable logistic regression analysis showed that the KTP laser resection method was associated with the presence of MM in specimens (P = 0.008). In addition, tumors with smaller sizes, which could also be en bloc resected with TURBt (e.g., ≤1 cm), had a higher presence of MM (P = 0.047).


En bloc resection improves the identification rate of MM, which may enhance the accurate identification of the T1 substage.


T1 substage En bloc resection Muscularis mucosae Non-muscle invasive bladder cancer 



This study was supported by the National Natural Science Foundation of China (No: 81572520) and the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University, China (No: XJTU1AF–CRF-2015–002 to DH) and International cooperation project of Shanxi, China (No: S2016YFKW0042). The authors appreciate Prof. Guanjun Zhang, from the Department of Pathology, the First Affiliated Hospital of Xi’an Jiaotong University, for help in this paper.

Author contributions

JHF: perform operation, project development, and manuscript editing. HL: data collection, manuscript writing, view pathological specimens. TY: data collection and manuscript writing. KJW: project development and manuscript writing. DLH: manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anPeople’s Republic of China
  2. 2.Department of PathologyThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anPeople’s Republic of China

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