Endoscopic Snare Resection of Bladder Tumors: Evaluation of an Alternative Technique for Bladder Tumor Resection*

Abstract

Transurethral resection of bladder tumor (TURBT) is the standard of care for initial bladder tumor management. In response to its shortcomings, we propose an alternative technique for tumor resection and retrieval: The endoscopic snare resection of bladder tumor (ESRBT). Eleven tumors managed by ESRBT were reviewed retrospectively. Via cystoscopy, tumors were resected en bloc with an electrosurgical polypectomy snare and retrieved transurethrally. Safety and efficacy were assessed by clinical and pathologic outcomes. ESRBT was highly effective for appropriate tumors. Tumor size and location varied: Two small, six medium, three large; six lateral wall, two dome, two trigone, one posterior wall. Half of initial urothelial carcinoma specimens contained muscle. There were no intraoperative or postoperative complications (mean follow-up: 17 mos; range 10-25 mos). ESRBT is a feasible technique for the resection of pedunculated bladder tumors. It offers evident and theoretical advantages over TURBT and may augment bladder tumor management. Further study is needed.

Trans-Urethral Snare of Bladder Tumor (TUSnBT) with Stone Basket Retrieval: A Novel Time-Saving Technique in the Endoscopic Management of Papillary Bladder Lesions

“…Where the lesion was difficult to immobilize, the basket was passed through a ureteric catheter into the standard instrument channel within the 24 F cystoscope. Our experience utilizing the TUSnBT method further confirms the feasibility, and convenience of the endoscopic snare in selecting papillary bladder lesions, as was reported in a previous series [9]. …”

“…Traditional TURBT has reported shortcomings; with elevated rates of incomplete resection (15-78%), under staging (34-62%) due to absence of detrusor muscle in 51% of specimens, and tumor recurrence (50-70%) [9]. Added to the above, the operative risks during TURBT include bleeding which impairs the visual field, bladder perforation, urethral orifice damage, irrigation fluid absorption which increases with procedure time, infection and obturator nerve stimulation [10].…”

“…Additionally, the TURBT procedure also performs systematic slicing of active tumor, which may result in tumor spreading, seeding and further implantation [3,9]. …”

“…Some are employed to allow for an en-bloc resection and others to achieve a more accurate endoscopic sampling (table 2) [4,9,10,11,12,13,14,15,16,17,18,19,20]. …”

“…Although the endoscopic resection of bladder tumors utilizing a snare has recently been described with the mesh net as the retrieval mechanism [9], this study is the first to assess the use of the TUSnBT with a conventional stone basket.…”