[En bloc transurethral resection for non-muscle invasive bladder cancer].

Abstract

Bladder cancer (BC) is a severe, and in some cases disabling disease for which no active detection strategy has been developed. It requires careful differential diagnosis, and is associated with a high risk for recurrence and progression. The choice of optimal treatment of non-muscle-invasive bladder Cancer (NMIBC) can reduce the rate of recurrence and improve oncologic outcomes. The development of the Vesical Imaging Reporting and Data System (VI-RADS) protocol, which has high sensitivity and specificity for assessing the degree of tumor invasion into the detrusor, has been changing the paradigm for primary surgical treatment. The use of new protocol VI-RADS for MRI and intraoperative protocols DEpth of Endoscopic Perforation (DEEP) determine the treatment tactics. Frequency of detrusor presence after en bloc resection is 96-100%. The absence of circulating tumor cells in the peripheral bloodstream during en bloc resection compared to classic transurethral resection (TUR) has been proven. Safety profile and morphologic specimen are better with use of laser energy. Repeat TUR after en bloc resection if there was a negative surgical margin and detrusor was present in the specimen is left to the discretion of the physician. The pathomorphological study after en bloc resection of the bladder allows a more precise staging and may influence on treatment tactics for bladder cancer. En bloc transurethral resection can be recommended as a standard procedure for diagnosis and treatment of NMIBC.