Transurethral resection of bladder tumor (TURBT) is first-line treatment of all kinds of bladder cancer. Clinical usage of TURBT is not only for treatment but also for diagnosis by accurate staging and grading.
Most of bladder cancer is diagnosed as non-muscle invasive tumor, but control of recurrence and progression is a major issue in bladder cancer management. Single, low-grade, noninvasive tumor could be treated by TURBT alone, but if there are any evidence of higher risk in pathologic specimen, additional treatment (instillation of BCG, chemotherapy, or early cystectomy) is essential.
TURBT is also important for accurate bladder cancer staging. Repeated TURBT (so-called second-look TURBT) and en bloc resection of urothelial carcinoma in bladder (EBRUC) are performed for satisfying these clinical needs. Prostatic urethra sampling and bladder random biopsy are also considered in TURBT procedure for gathering clinical information for decision-making.
There is a consensus that all visible papillary tumors should be resected in TURBT procedure. The EAU guideline strongly recommends acquisition of underlying detrusor muscle and adjuvant tissue of papillary tumor by en bloc resection in small tumor or separate resection in large tumor. Although AUA and NCCN do not mentioned about underlying detrusor muscle in initial TURBT, it should take on re-TURBT procedure or in the case of T1 high-grade tumor.
Transurethral resection of bladder tumor En bloc resection Repeated TURBT Prostate urethra biopsy Bladder random biopsy
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