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PubMed2001

[The sensitivity and clinical implications of periodical bladder biopsy following transurethral resection of superficial bladder transitional cell carcinoma].

The role of the periodical bladder biopsy after transurethral resection (TUR-Bt) of superficial bladder cancer (sBT) was evaluated. Sixty-four patients (85 TURs) with sBT who underwent TUR-Bt between 1993 and 1998 were divided into 14 (22 TURs) who had carcinoma in situ (CIS) at the first TUR (group A), and 50 (64 TURs) who had papillary tumors without concomitant CIS (group B). Post-TUR intravesical instillation was performed with bacillus Calmette-Guerin for the majority of group A, and mitomycin C for the majority of group B. The first biopsy was performed at 3 months postoperatively, and the second biopsy was done at 8 to 12 months postoperatively. The mean observation time was 4 years and 6 months. Residual cancer was detected in 7 out of 34 biopsies (20.6%) in group A, and 19 out of 94 (20.2%) in group B. Every residual lesion in group A was CIS with negative cytology. In group B, with exclusion of 11 recurrent papillary tumors, the detection rate was only 8/83 (9.6%). In both groups, even in the cases with no sign of disease in biopsies, the recurrence immediately after the termination of the biopsy protocol was common. The progression of the cancer was more frequent in group A (4 patients), than in group B (2 patients) (p < 0.01, log-rank test), and no case in group B showed local progression. The periodical biopsy may have a certain, but limited advantage over conventional examinations. A less invasive and more sensitive method in awaited.

Biopsy↗

PubMed1989

Urethral strictures after transurethral bladder tumor resection.

The charts on 241 patients, consecutively undergoing a total of 2043 transurethral resections of bladder tumors and subsequent controls, were reviewed to find the incidence and possible causes of postoperative urethral stricture. The incidence of urethral stricture was 15% in males and 4% in females, but less than one-third were symptomatic. The strictures were found distally in the urethra in 83% of the patients and were treated with optical urethrotomy. Cumulated duration of postoperative catheterization was significantly longer and size of resectoscope used larger in patients with stricture. Repeated transurethral instrumentations may increase the risk of stricture development.

Female↗

PubMed2006

Risk of post-operative intravesical mitomycin C instillation following transurethral bladder tumor resection.

Bladder cancer is the fifth most common cancer in the Western world and is on the rise. Most patients present with superficial disease and are treated by transurethral resection of bladder tumor. More than half of these patients experience recurrence with about 20% progressing to muscle invasive disease. Intravesical chemotherapy has been shown to decrease the risk of recurrence of bladder cancer. Mitomycin C has emerged as a major agent for an immediate post-resection intravesical instillation. This article reviews the literature on the mode of action, rationale for immediate adjuvant treatment with Mitomycin C and adverse effects associated with its use.

Administration, Intravesical↗

PubMed1997

Transurethral bladder tumor resection alters fibronectin expression in transitional carcinoma cell lines.

PURPOSE: To examine the effect of TGF beta 1 and post-transurethral resection of bladder tumor (TURBT) urine on fibronectin (FN) expression by transitional carcinoma (TCC) cell lines. MATERIALS AND METHODS: Northern analysis and rtPCR for mRNA transcripts, in combination with ELISA and immunohistochemistry for protein, were used to quantify the effect of TGF beta 1 and post-TURBT urine on cellular expression of FN in two TCC lines, 253J and 647V. The TGF beta 1-dependent nature of the response seen in post-TURBT urine was confirmed using exogenous TGF beta 1 or blocking antibodies to TGF beta 1. Active and latent levels of TGFb1 were measured in post-TURBT urine and urine "spiked" cell culture media. RESULTS: Baseline FN expression was low in the poorly differentiated, metastatic 253J line and high in the moderately differentiated 647V line. TGF beta 1 and post-TURBT urine increased FN expression at both the mRNA and protein levels in the 253J line. Anti-TGF beta 1 antibodies inhibited the effect of post-TURBT urine on FN expression in 253J cells. High levels of TGF beta 1 decreased FN expression in 647V cells. Only latent TGF beta 1 was present in samples of urine and media. CONCLUSIONS: FN production in low expressing TCC lines can be augmented by exogenous TGF beta 1. TURBT increases latent urinary TGF beta 1 which in turn affects TCC FN expression. Altered tumor expression of FN following TURBT may influence the effectiveness of intravesical BCG.

Carcinoma, Transitional Cell↗

PubMedDate not supplied

[The intraoperative ultrasonic control of the radicalness of transurethral resection in bladder cancer].

72 patients with bladder cancer stage T1, T2 underwent transurethral resection of the bladder wall affected with tumor under ultrasound control of the removal radicality. The evidence obtained at transurethral ultrasound scanning was compared to the findings of histological examination of the tissue removed. The accuracy of the control made up 87.3%. This made it possible to follow tumor invasion from the tumor margins along the periphery in accordance with blastomatosis stage. The authors have developed a technique of transurethral resection of bladder wall under transurethral ultrasonic scanning as control of the removal radicality.

Evaluation Studies as Topic↗

PubMed2003

Effect of routine repeat transurethral resection for superficial bladder cancer: a long-term observational study.

PURPOSE: We determined the long-term outcome in patients with superficial bladder cancer (Ta and T1) undergoing routine second transurethral bladder tumor resection (ReTURB) in regard to recurrence and progression. MATERIALS AND METHODS: We performed an inception cohort study of 124 consecutive patients with superficial bladder cancer undergoing transurethral resection and routine ReTURB (83) between November 1993 and October 1995 at a German university hospital. Immediately after transurethral resection all lesions were documented on a designed bladder map. ReTURB of the scar from initial resection and other suspicious lesions was performed at a mean of 7 weeks. Patients were followed until recurrence or death, or a minimum of 5 years. RESULTS: Residual tumor was found in 33% of all ReTURB cases, including 27% of Ta and 53% of T1 disease, and in 81% at the initial resection site. Five of the 83 patients underwent radical cystectomy due to ReTURB findings. The estimated risk of recurrence after years 1 to 3 was 18%, 29% and 32%, respectively. After 5 years 63% of the patients undergoing ReTURB were still disease-free (mean recurrence-free survival 62 months, median 87). Progression to muscle invasive disease was observed in only 2 patients (3%) after a mean observation of 61 months. CONCLUSIONS: These data suggest a favorable outcome regarding recurrence and progression in patients with superficial bladder cancer who undergo ReTURB. ReTURB is suggested at least in those at high risk when bladder preservation is intended.

Adult↗

PubMed1983

Urinary infections following transurethral resection of bladder tumors--rate and source.

The incidence of urinary infection and its source after transurethral resection of bladder tumors were investigated. Patients undergoing transurethral prostatectomy constituted the control group. All patients had proved preoperative sterile urine and did not receive any antimicrobial treatment. The incidence of urinary infection following transurethral resection of bladder tumors was 19.4 per cent, with an incidence of positive tumor chip cultures of 3.2 per cent. The incidence of urinary infection after transurethral prostatectomy was 32 per cent, with an incidence of positive prostate chip cultures of 8 per cent. We concluded that the source of urinary infection following transurethral resection of bladder tumors and transurethral prostatectomy in most cases is not from within the tissue but rather from perioperative manipulations.

Humans↗

PubMed1987

[Elimination of the obturator reflex with prilocaine in transurethral resection of bladder tumors in combination with spinal and general anesthesia].

During transurethral resection of bladder tumors under either spinal or general anesthesia without muscular relaxation, direct stimulation of the obturator nerve by the electroresectoscope is possible. The resulting obturator reflex may lead to severe complications, at the worst to a perforation of the bladder. Therefore, if resection in lateral bladder regions is necessary, blockade of the obturator nerve is often required to provide optimal conditions for transurethral resection of bladder tumors. To interrupt the obturator reflex are, we blocked the inguinal lumbar plexus using the "3-in-1-block" as described by Winnie because of its advantages compared to isolated blockade of the obturator nerve. Prilocaine 1% was the chosen local anesthetic because of its low tendency towards cardiac and cerebral side effects. Spinal anesthesia was induced with 3-4 ml hyperbaric bupivacaine 0.5%. After the onset of analgesia, making use of a nerve stimulator, a "3-in-1-block" was completed with 30-35 ml prilocaine 1%. The study included over 90 patients. Firstly we observed the efficiency of the obturator motor block by the "3-in-1-block"; secondly clinical side effects of prilocaine were evaluated; and finally in 20 cases methemoglobin levels were measured before and 90 min after injection of prilocaine. A "3-in-1-block" with prilocaine 1% provided a good motor block of the obturator nerve. Neither clinical side effects nor relevant methemoglobinemia occurred. In 3 cases methemoglobin levels were elevated by 1%, whereas in the remaining 17 cases methemoglobin values were normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗

PubMed2004

[Transurethral resection of bladder tumours in sodium chloride solution].

BACKGROUND: Electrical transurethral resection is a well established and developed procedure. It is performed using high frequency current in a nonconductive irrigation medium. Due to these features this procedure is compromised by two possible complications: (1) spontaneous contractions of adductors caused by electrical stimulation of the obturator nerve may lead to bladder perforation, and (2) excessive flushing of the irrigation medium into the circulation can cause TUR syndrome. We present our initial experiences with a new system for transurethral resection which has overcome these potential sources of complications. The system, developed by Olympus, works with a modified guided high frequency current in 0.9% saline as irrigant. It is called TURIS (transurethral resection in saline). METHODS: A total of 35 resections of bladder tumors were performed using the TURIS technique. The operations were carried out under intravenous anaesthesia without relaxation or nerve block. During resection high frequency current passes through and active electrode (resection loop) to the sheath electrode. About 90% of the current flows through the saline to the sheath of the resectoscope, only a small amount circulates through the body of the patient. The experiences of the surgeons were documented. The resected specimens were histologically examined for artificial thermal changes and compared with a control group of conventionally resected patients. RESULTS: The handling of the TURIS resectoscope is very similar to that of well known instruments. Therefore, no special training was required for the surgeon or the theatre nurse. The control of the cutting was very efficient. Coagulation of bleeding was very good. The lack of carbonisation at the resection ground led to an excellent assessment of the resected areas. The resected tissue did not stick to the resection loop. Contraction due to nerve stimulation was not observed. No complications occurred. Histology showed no significant differences in the quantity or quality of thermal artifacts due to current. CONCLUSIONS: TURIS can be performed safety without a learning curve. Especially in TUR-B, it seems to be advantageous due to the excellent control of the extent of cutting and the lack of nerve stimulation. Quantity and quality of thermal changes in histology are not different from a conventionally resected control group.

Aged↗

PubMed1998

Evaluation of new resectoscope loop for transurethral resection of bladder tumors.

PURPOSE: We evaluate a new resectoscope loop for transurethral resection of bladder tumors. MATERIALS AND METHODS: Of 251 transurethral resections in 226 patients 111 were done with a conventional loop and 140 with the Olympus prototype model A2186 resectoscope loop. The quality of specimens provided for histological analysis was compared. RESULTS: Tissue orientation was preserved and cautery artifact was reduced with the new loop compared to the standard resectoscope loop. CONCLUSIONS: Compared to a conventional resectoscope loop, the new loop resulted in a better tumor resection and helped facilitate histological evaluation of the tissue specimens.

Endoscopes↗

PubMed1993

The essentials of transurethral resection of bladder tumors (TUR-B).

The technique of transurethral resection of bladder tumors has to follow certain rules to guarantee that all parts of the bladder are visualized, that small tumors are completely removed and large tumors resected without complications. A second resection 6-8 weeks after the first procedure seems to be necessary for complete tumor removal even in case of low stage cancer.

Humans↗

PubMed2003

En bloc transurethral resection of bladder tumors: use and limits.

OBJECTIVES: To evaluate the feasibility and safety of transurethral en bloc resection of bladder tumors using a flat loop. Transurethral en bloc resection of bladder tumors facilitates pathologic evaluation. METHODS: A total of 37 patients with papillary transitional cell carcinoma of the bladder underwent transurethral en bloc resection with the use of a flat loop electrode. RESULTS: In 37 patients, 62 lesions were removed using a flat loop to perform the en bloc technique. This method is safe to perform in the case of papillary tumors with a diameter of up to 25 mm and that are found in specific areas of the bladder. CONCLUSIONS: It is both safe and feasible to perform en bloc resection with a flat loop electrode but attention must be paid to the limitations of this technique. Excellent pathologic evaluation of the grade and stage of the removed specimen is possible.

Aged↗

PubMed2006

Risk factors for adverse outcomes after transurethral resection of bladder tumors.

BACKGROUND: Risk factors for adverse outcomes after transurethral resection of bladder tumors (TURBT) have not been identified to date. Such information would facilitate preoperative risk stratification and case-mix-adjusted outcome comparison, and lead to the development of processes of care directed at improving outcomes and ultimately the quality of care for bladder carcinoma patients. METHODS: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. Since 1991, a total of 21,515 TURBTs have been prospectively registered by the NSQIP; these cases compose the current study population. Using multivariable logistic regression, the authors determined the independent association between preoperative patient risk factors and perioperative elements of structure/process and morbidity, mortality, and prolonged length of stay (LOS) outcomes. RESULTS: The postoperative complication, 30-day, and 90-day mortality rates were 4.3%, 1.3%, and 3.3%, respectively. The median, 75th percentile, and 90th percentile for LOS among patients undergoing TURBT was 2 days, 3 days, and 8 days, respectively. Robust preoperative patient risk factors that were found to be uniformly associated with all adverse outcomes included the presence of disseminated disease (odds ratio [OR], 1.9-5.2) weight loss (OR, 1.8-3.8), low serum albumin (OR, 2.3-7.1), elevated serum creatinine (OR, 1.3-2.9), a dependent functional status (OR, 1.5-2.7), and emergent case status (OR, 1.8-3.1). Compared with models using preoperative patient factors alone, models including perioperative structure and process measures explained further variation in surgical outcomes (each likelihood ratio test, P < .0001). CONCLUSIONS: The findings of the current study highlight the fact that there are a wide array of patient risk factors that are associated with adverse outcomes after TURBT. Validation of those processes implemented to modify such elements can provide a basis for quality metrics in the context of TURBT.

Aged↗

PubMed1981

[Transurethral resection in bladder tumors].

The experience gained in the course of 127 transurethral resections of bladder tumours are described. After discussing the indications and the technique the authors present their own results. The advantages of transurethral resection are emphasized: reduced operational stress, early mobilization, quick removal of the catheter, few postoperative complications, low cost of nursing. Therefore the operation is given preference mainly in the treatment of elderly patients with bladder tumour.

Adult↗

PubMed1983

[An analysis of complications following transurethral resection of bladder tumors].

On the basis of 404 transurethral resections of tumours of the urinary bladder a report is given on complications and their prevention. Among 404 tumour resections 4 perforations of the bladder occurred (0.9%). The extraperitoneal perforations were simply paravesically drained; the intraperitoneal ones were oversewn and intraperitoneally drained. Post-operative bleeding was well controlled by means of a continuous wash via an additional thin catheter (Charr. 7-8) fitted into the urethra. Patients with existing infections of the urinary passages were traget-specifically treated with antibiotics. The careful coagulation of all bleeding vessels already when cutting is necessary. The good visibility thus achieved reduces the risk of perforation. If wash fluid begins to extravasate intravenous administration of 10% saline solution will prevent any hyponatraemia.

Aged↗

PubMed2002

Do patients profit from 5-aminolevulinic acid-induced fluorescence diagnosis in transurethral resection of bladder carcinoma?

OBJECTIVES: To evaluate in a prospective study the influence of fluorescence diagnosis (FD) controlled transurethral resection of bladder tumors on therapeutic consequences. The aim was to determine in how many patients FD led to a change in treatment strategy compared with conventional white light (WL) cystoscopy. METHODS: A total of 279 patients with suspected bladder tumors underwent transurethral resection using FD in addition to WL cystoscopy. The number of additional tumor-positive patients, staging change, number of multilocular tumors exclusively detected by FD, and resulting therapeutic consequences compared with the results after WL cystoscopy were investigated. In addition a biopsy-based evaluation was performed. RESULTS: Tumor or dysplasia II degrees (moderate dysplasia) was detected in 177 patients. In 168 patients, tumor was detected by WL cystoscopy, and in 9 (5.1%) of the patients, tumor was completely overlooked by WL cystoscopy and diagnosed exclusively by FD (n = 3 TaG1-G2, n = 2 carcinoma in situ, n = 1 greater than T1, and n = 3 dysplasia II degrees ). Multilocular tumor involvement was detected in 10 cases using FD, and a change in the stage by detection of coexisting dysplasia II degrees and carcinoma in situ occurred in 8 patients. In 27 patients (15.3%), additional information was obtained by exclusive detection of tumors by FD. This resulted in a change in the treatment strategy for 16 patients (9%). CONCLUSIONS: FD leads to an improvement in the diagnosis of bladder carcinoma. It allows the early selection of the best treatment option and thus has a potentially positive effect on the prognosis of the affected patients.

Adult↗

PubMed2002

[Right primary iliac artery rupture during transurethral resection of bladder tumor].

Injury to a large-caliber artery transurethral resection of a bladder tumor is a rare but serious complication. It is important that an anesthesiologist be able to detect such an injury, in order to include it among the many differential etiological diagnoses for shock. A 75-years-old man reported hematuria. An ultrasound image of the bladder showed many neoformations consistent with a diagnosis of multiple bladder neoplasms, and transurethral endoscopy was performed under subarachnoid anesthesia. Acute hypotension, bradycardia and shock developed 30 minutes into the procedure. The diagnosis was hypovolemic shock due to acute intraoperative hemorrhage, and exploratory laparotomy revealed an opening in the common iliac artery. The rupture was sutured. In spite of administration of crystalloids, colloids, blood products and vasoactive agents, a second operation was required due to hemodynamic instability. The patient died in the intensive care unit.

Aged↗

PubMed1990

[Absorption of tetrahydropyranyl adriamycin administered intravesically immediately after transurethral resection of bladder carcinoma].

Absorption of tetrahydropyranyl adriamycin (THP) administered immediately after transurethral resection of bladder carcinoma (TUR-Bt) has not been reported. In this study, we have examined the absorption of THP and the systemic toxicity in the early post-TUR period. Of 21 patients with bladder carcinoma, 10 had a solitary tumor and 11 multiple tumors. Twenty mg THP in 40 ml of sterile water was intravesically administered on days 1, 3, 5, 7, 14 and 28, and then every 4th week. The THP solution was retained for 2 hours. The blood THP concentration was measured 30 minutes and 2 hours after the intravesical administration on days 1, 7 and 28. No systemic side effects were observed. Thirteen of the 38 (34%) samples contained a detectable level (more than 1 ng/ml) of THP on the post-TUR-Bt on day 1, 8, of 42 (19%) on day 7, and 3 of 18 (17%) on day 28. Altogether, 24 of the 98 (24%) samples contained more than 1 ng/ml THP. The highest blood THP level was 23 ng/ml on day 1. The differences between frequency of detection of blood THP in the samples at 30 minutes and 2 hours were not statistically significant. The difference between average concentration of blood THP of patients with solitary and multiple tumors also was not significant. These results indicate that intravesical THP administration starting within 24 hours after TUR-Bt can not result in significant systemic absorption of THP, and the systemic toxicity can be avoided.

Absorption↗