Introduction & Objectives:
Transurethral resection of large bladder tumor on lateral wall can make obturator jerk and have a large main feeding vessel. Therefore, some preventive methods are needed before resecting. There are nerve block, limited filling of bladder and reduced cutting current were suggested by researchers. Moreover, We has invented a new en bloc retrograde resection method. This study conducted to evaluate the safety and efficacy of a new retrograde en bloc resection of bladder tumor (RERBT) with conventional bipolar resection (C-TURBT) for the treatment of large superficial bladder tumors.
Materials & Methods:
RERBT and C-TURBT were conducted, respectively, in 40 and 50 patients diagnosed with superficial papillary bladder tumors. Of these, 25 patients (in ERBT) and 35 (in TURBT) had more than 3cm sized of bladder tumor. The tumors were en bloc removed with flash-firing fashion retrogradely using a roller bar electrode under pushing upward the main mass. After resecting the mass, 4-5 piece of mass could be retrieved with glass syringe under high negative pressure in RERBT group and while in C-TURBt group, anterogradely resected using biopolar cutting loop. Patients’ clinicopathological, intraoperative, and postoperative data were compared retrospectively between the RERBT and C-TURBT groups.
Results:
Both groups were comparable in clinicopathological characteristic. RERBT could be performed as safely and effectively as C-TURBT. There were no significant differences in operative time. However, in event of obturator jerk, C-TURBT would made more event of bladder puncture than the RERBT, bladder puncture due to obturator was happened at 5 patients (10%). During the resection, bleeding time was longer in C-TURBT(15.3m) than RERBT group (5.0m) (p < 0.01). The cumulative recurrence rates between groups were similar during up to 18 months follow-up. The detrusor muscle could be identified pathologically in 100% of RERBT tumor specimens and the biopsy of tumor bases, but only in 54 and 70%, respectively, of C-TURBT samples (P < 0.01).
Conclusions:
The RERBT technique is feasible and safe for superficial bladder tumors using conventional bipolar resection setting, with the advantages of adequate tumor resection and the ability to collect good quality tumor specimens for pathological diagnosis and staging compared to conventional TURBT. It also would be avoid major bleeding event and the bladder puncture due to obturator jerk
