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Introduction Previously, in a randomised trial we demonstrated bipolar transurethral resection of bladder tumor (TURBT) could achieve a higher detrusor sampling rate than monopolar TURBT. We hereby report the long-term oncological outcomes following study intervention. Methods This is a post-hoc analysis of a randomized phase III trial comparing monopolar and bipolar TURBT. Only patients with pathology of non-muscle invasive bladder cancer (NMIBC) were included in the analysis. Per-patient analysis was performed. Primary outcome was recurrence-free survival (RFS). Secondary outcomes included progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). Results From the initial trial, 160 cases were randomised to receive monopolar or bipolar TURBT. 24 cases of non-urothelial carcinoma, 22 cases of muscle-invasive bladder cancer, and 9 cases of recurrences were excluded. A total of 97 patients were included in the analysis, with 46 in the monopolar and 51 in the bipolar group. The median follow-up was 97.1 months. Loss-to-follow-up rate was 7.2%. Regarding the primary outcome of RFS, there was no significant difference (HR = 0.731; 95%CI = 0.433–1.236; P  = 0.242) between the two groups. PFS (HR = 1.014; 95%CI = 0.511–2.012; P  = 0.969), CSS (HR = 0.718; 95%CI = 0.219–2.352; P  = 0.584) and OS (HR = 1.135; 95%CI = 0.564–2.283; P  = 0.722) were also similar between the two groups. Multifocal tumours were the only factor that was associated with worse RFS. Conclusion Despite the superiority in detrusor sampling rate, bipolar TURBT was unable to confer long-term oncological benefits over monopolar TURBT.

Introduction Bladder cancer (BCa) is characterised by high prevalence, multifocality, and frequent recurrence, imposing significant clinical and economic burdens. Accurate staging, particularly distinguishing non‐muscle‐invasive bladder cancer (NMIBC) from muscle‐invasive bladder cancer (MIBC) disease, is crucial for guiding treatment decisions. This narrative review explores the potential implications of incorporating multiparametric magnetic resonance imaging (mpMRI) and the Vesical Imaging Reporting Data System (VI‐RADS) into BCa staging, focusing on repeat transurethral resection of bladder tumour (re‐TURBT). Methods A comprehensive search of PubMed, EMBASE, and MEDLINE databases identified studies published from 2018 to 2023 discussing mpMRI or VI‐RADS in the context of re‐TURBT for BCa staging. Studies meeting inclusion criteria underwent qualitative analysis. Results Six recent studies met inclusion criteria. VI‐RADS scoring, accurately predicted muscle invasion, aiding in NMIBC/MIBC differentiation. VI‐RADS scores of ≥3 indicated MIBC with high sensitivity and specificity. VI‐RADS potentially identified patients benefiting from re‐TURBT and those for whom it could be safely omitted. Discussion mpMRI and VI‐RADS offer promising prospects for BCa staging, potentially correlating more closely with re‐TURBT and radical cystectomy histopathology than initial TURBT. However, validation and careful evaluation of clinical integration are needed. Future research should refine patient selection and optimise mpMRI's role in BCa management. Conclusion VI‐RADS scoring could revolutionise BCa staging, especially regarding re‐TURBT. There is potential that VI‐RADS correlates more with the histopathology of re‐TURBT and radical cystectomy than initial TURBT. While promising, ongoing research is essential to validate utility, refine selection criteria, and address economic considerations. Integration of VI‐RADS into BCa staging holds potential benefits for patients and health care systems.

Purpose En bloc resection of bladder tumors (ERBT) may improve staging quality and perioperative morbidity and influence tumor recurrence. This study was designed to evaluate the safety, efficacy, and recurrence rates of electrical versus laser en bloc resection of bladder tumors. Methods This European multicenter study included 221 patients at six academic hospitals. Transurethral ERBT was performed with monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative parameters, and 12-month follow-up data was analyzed. Results Electrical and laser ERBT were used to treat 156 and 65 patients, respectively. Median tumor size was 2.1 cm; largest tumor was 5 cm. Detrusor muscle was present in 97.3 %. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3 vs. 1.5 %, p  < 0.001). Median operation duration (25 min), postoperative irrigation (1 day), catheterization time (2 days), and hospitalization (3 days) were similar. Overall complication rate was low (Clavien ≥ 3, n  = 6 [2.7 %]). Hemoglobin was significantly lower after electrical ERBT ( p  = 0.0013); however, overall hemoglobin loss was not clinically relevant (0.38 g/dl). Patients ( n  = 148) were followed for 12 months; 33 (22.3 %) had recurrences. In total, 63.6 % recurrences occurred outside the ERBT resection field. No difference was noted between ERBT groups. Conclusions ERBT is safe and reliable regardless of the energy source and provides high-quality resections of tumors >1 cm. Recurrence rates did not differ between groups, and the majority of recurrences occurred outside the ERBT resection field.

PurposeTo learn about the history and development of en bloc resection of bladder tumour (ERBT), and to discuss its future directions in managing bladder cancer.MethodsIn this narrative review, we summarised the history and early development of ERBT, previous attempts in overcoming the tumour size limitation, consolidative effort in standardising the ERBT procedure, emerging evidence in ERBT, evolving concepts in treating large bladder tumours, and the future directions of ERBT.ResultsSince the first report on ERBT in 1980, there has been tremendous advancement in terms of its technique, energy modalities and tumour retrieval methods. In 2020, the international consensus statement on ERBT has been developed and it serves as a standard reference for urologists to practise ERBT. Recently, high-quality evidence on ERBT has been emerging. Of note, the EB-StaR study showed that ERBT led to a reduction in 1-year recurrence rate from 38.1 to 28.5%. An individual patient data meta-analysis is currently underway, and it will be instrumental in defining the true value of ERBT in treating non-muscle-invasive bladder cancer. For large bladder tumours, modified approaches of ERBT should be accepted, as the quality of resection is more important than a mere removal of tumour in one piece. The global ERBT registry has been launched to study the value of ERBT in a real-world setting.ConclusionERBT is a promising surgical technique in treating bladder cancer and it has gained increasing interest globally. It is about time for us to embrace this technique in our clinical practice.

Objective: To compare the frequency and severity of post-operative CRBD in patients undergoing TURP and TURBT with spinal anaesthesia with pudendal nerve block against spinal anaesthesia alone. Study Design: A randomized controlled trial (Clinical trials.gov: NCT05022160) Place and Duration of Study: Armed Forces Institute of Urology (AFIU), Rawalpindi Pakistan, from Aug to Nov, 2021. Methodology: The trial comprised 250 patients scheduled to have a transurethral resection of the prostate (TURP) or a transurethral resection of a bladder tumour (TURBT) under spinal anaesthesia. They were split into two groups: study (group-P) and control (group-C). After surgery, the patients in the study-group were given a bilateral pudendal nerve block. At 3, 8, 12, and 24 hours following surgery, the frequency and severity of catheter-related bladder discomfort (CRBD) were documented. Results: CRBD frequencies were significantly lower in pudendal group at 3 hours 42 (33.8%) vs 72 (58.5%), p <0.001), 8 hours 81 (65.3%) vs 111 (90.2%), p<0.001 and 12 hours 53 (42.7%) vs 73 (59.3%), p=0.009 after the surgery. The postoperative pain score in pudendal group was lower at 3 hours (p<0.001), 8 hours (p <0.001), and 12 hours (p=0.02) but there was no statistically significant difference between the two groups at 24 hours (p=0.06). Conclusion: When used in conjunction with spinal anaesthesia, a pudendal nerve block reduces the frequency and severity of catheter-related bladder discomfort for up to 12 hours after surgery.

PurposeTo investigate the technical success rate and 30-day complications of en-bloc resection of bladder tumour (ERBT) upon routine implementation regardless of tumour size.MethodsThis is a prospective, multi-centre, study on routine implementation of ERBT for patients with bladder tumours requiring transurethral surgery. Surgeons were allowed to cross over to conventional transurethral resection of bladder tumour (TURBT) when necessary. We performed an analysis for patients who had ERBT/TURBT as the definitive treatment. Study outcomes included the technical success rate of ERBT and 30-day complication rate. Multivariate logistic regression analysis was performed to investigate for predictors of a successful ERBT and factors associated with 30-day complications.ResultsA total of 135 patients were included in this study. The majority of the patients (80.0%) had bladder tumours of ≤ 3 cm. ERBT was successful in 99 patients, resulting in an overall technical success rate of 73.3%. When stratified according to tumour size, the technical success rates of ERBT were 94.3%, 82.2%, 75%, 84.3% and 29.6% for bladder tumour sizes of < 1 cm, 1.01–2 cm, 2.01–3 cm, ≤ 3 cm and > 3 cm respectively. Upon multivariate analysis, tumour size was the only significant factor predicting the success of ERBT (OR 0.920, 95% CI 0.882–0.960, p < 0.001). Moreover, ERBT was not a significant factor associated with 30-day complications.ConclusionEBRT achieved a good technical success rate for the majority of patients with bladder tumours ≤ 3 cm. Regardless of tumour size, EBRT-first approach was safe to implement into routine clinical practice.

Background Bladder cancer (BCa) diagnosis relies on distinguishing muscle-invasive bladder cancer (MIBC) from non-muscle-invasive bladder cancer (NMIBC) forms. Transurethral resection of the bladder tumor (TURBT) is a standard procedure for initial staging and treatment. The Vesical Imaging-Reporting and Data System (VI-RADS) enhances diagnostic accuracy for muscle invasiveness through advanced imaging techniques, potentially reducing reliance on repeat TURBT and improving patient management. Objective We aimed to evaluate the role of VI-RADS in predicting muscle invasiveness in BCa and its potential to predict adverse pathology in high-risk NMIBC to avoid unnecessary repeat TURBT procedures. Methods In this prospective study, we included 62 patients over the age of 18 years who underwent TURBT. In a secondary phase, patients selected for restaging TURBT (re-TURBT) were included, but those with T2 tumors or low-risk NMIBC were excluded. Multiparametric magnetic resonance imaging (MRI) examinations were scored by a radiologist using the VI-RADS 5 method, while a pathologist analyzed TURBT and re-TURBT samples for accurate staging. Statistical analysis evaluated the role of VI-RADS in BCa staging. Results The VI-RADS score was the only predictive factor for muscle invasion in multivariate analysis. Setting the VI-RADS score at >3 resulted in the highest sensitivity, specificity, and diagnostic accuracy, with values of 67.0%, 89.0%, and 78%, respectively. The receiver operating characteristic area under the curve score for VI-RADS for muscle invasion was 85% for stage Ta, 61% for stage T1, and 88% for stage T2, which shows the utility of VI-RADS in the predictiveness of MIBC/NMIBC. Conclusion VI-RADS is effective in stratifying BCa patients by predicting muscle invasiveness and identifying NMIBC cases that may not need repeat TURBT.

BackgroundAmong patients with non-muscle-invasive bladder cancer (NMIBC), systematic reviews showed lower recurrence rate in patients treated with photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) than with white-light (WL) TURBT. However, the result is not consistent between clinical trials and the significance of preoperatively available factors in disease recurrence after PDD-TURBT remains unclear.MethodsThe present study retrospectively analyzed 1174 NMIBC patients who underwent TURBT and were followed up for ≥ 6 months. Among 1174 patients, 385 and 789 underwent PDD-TURBT with oral 5-aminolevulinic acid (the PDD group) and WL-TURBT (the WL group), respectively. Recurrence-free survival (RFS) was compared between the PDD and WL groups before and after propensity score matching, and the impact of several baseline parameters on RFS between the 2 groups was investigated after matching.ResultsBefore propensity score matching, RFS was significantly longer in the PDD group than in the WL group (P = 0.006). After matching, 383 patients were included in both groups, and RFS was significantly longer in the PDD group than in the WL group (P < 0.001). In the cohort after matching, RFS between the two groups was compared in each subgroup classified according to baseline parameters, including age, sex, history of previous or concomitant upper urinary tract urothelial carcinoma, preoperative urinary cytology, tumor multiplicity, and tumor size, and significantly longer RFS was observed in the PDD group in all subgroups, except for the patients with tumors ≥ 30 mm (P = 0.21).ConclusionThese results suggest that PDD-TURBT prolongs RFS in NMIBC patients, except for those with tumors ≥ 30 mm.

Purpose To investigate whether the effect of intravenous bolus doses of dexmedetomidine on postoperative catheter-related bladder discomfort (CRBD) was dose-dependent in male patients undergoing transurethral resection of bladder tumors (TURBT). Methods The study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR 2,000,034,657, date of registration: July 14, 2020). Adult male patients were randomized to one of four groups: placebo (Group C); dexmedetomidine 0.2 µg/kg (Group D 0.2); dexmedetomidine 0.5 µg/kg (Group D 0.5); or dexmedetomidine 1 µg/kg (Group D 1). The primary outcome was the incidence of moderate-to-severe CRBD at 0, 1, 6, 24, and 48 h postoperatively. Results The incidence of moderate-to-severe CRBD was significantly lower in Group D 0.5 and Group D 1 than in Group C at 0 h (13% vs. 40%, P  = 0.006; 8% vs. 40%, P  = 0.001), 1 h (15% vs. 53%, P  < 0.001; 13% vs. 53%, P  < 0.001), and 6 h (10% vs. 32%, P  = 0.025; 8% vs. 32%, P  = 0.009) postoperatively. Compared with baseline, both the MAP and HR were significantly lower in Group D 1 at 1 min ([94 ± 15] vs. [104 ± 13] mm Hg, P  = 0.003; [64 ± 13] vs. [73 ± 13] bpm, P  = 0.001) and 30 min ([93 ± 10] vs. [104 ± 13] mm Hg, P  < 0.001; [58 ± 9] vs. [73 ± 13] bpm, P  < 0.001) postextubation. Conclusion The effect of intravenous bolus doses of dexmedetomidine on postoperative CRBD was dose-independent, whereas intravenous administration of 0.5 µg/kg dexmedetomidine reduced the early postoperative incidence of CRBD with minimal side effects. Trial registration Clinical trial number and registry URL: ChiCTR 2,000,034,657, http://www.chictr.org.cn , date of registration: July 14, 2020.

The study aimed to explore the distribution of circulating tumor cells (CTCs), circulating tumor endothelial cells (CTECs), and their subtypes in non-cancer and bladder cancer individuals, focusing on their prognostic value in high-risk non-muscle invasive bladder cancer (NMIBC). Researchers analyzed 59 fresh peripheral blood samples using subtraction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH). Samples were collected from healthy individuals (n = 18), patients with benign urinary conditions (n = 2), newly diagnosed bladder cancer patients (n = 20), and NMIBC patients after repeated transurethral resection of bladder tumor (R-TURBT) (n = 19). NMIBC patients had significantly higher total CTCs. In newly diagnosed bladder cancer patients, large CTCs constituted 58.8%. The most common karyotype was ≥ pentaploid CTCs (61.2%). In the non-cancer group, large CTCs constituted 83.0%, with ≥ pentaploid CTCs comprising 72.3% of aneuploid CTCs. For NMIBC patients after R-TURBT, those without recurrence had 16% small CTCs. Conversely, the recurrence group had 71% small CTCs, where tetraploid CTCs were predominant (40%). By performing logistic ridge repression, the ≥ pentaploid small CTC is noted as an important indicator of recurrence. The presence and proportion of small CTCs can serve as a prognostic marker in NMIBC patients following R-TURBT, potentially guiding patient management and surveillance strategies.