الفهرس 
Epidemiology of bladder cancer
Pathology of bladder cancerOnly 14 pages are availabe for public view
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Abstract
Non-muscle invasive bladder cancer (NMIBC) represents about
75–85% of the bladder cancers. Transurethral resection of bladder
tumour (TURBT) is the ”gold standard” procedure for management of
NMIBC.
In contrast to conventional (cTURBT) which includes piecemeal
resection of the tumour which is fragmented to be resected and
retrieved from the bladder, en-bloc (eTURBT) includes uprooting of
the whole tumour in one piece providing an intact specimen for
accurate pathological evaluation with low risk of scattering malignant
cells, and minimum bleeding during resection. Thus, it overcomes the
major drawbacks of cTURBT.
In our study, we evaluated efficacy and safety as well as
oncological outcomes of bipolar en-bloc transurethral resection of
bladder tumour (eTURBT) suggesting it as a standard technique in
management of patients with small primary bladder mass suspected to
be NMIBC.
Our study included 63 patients with primary bladder mass who
have attended to Uro-oncology unit, Urology department, Tanta
University hospitals in the duration (from the beginning of June 2019 to
the end of May 2020).
After fulfilling criteria of patients’ privacy and ethical merits,
patients underwent thorough preoperative evaluation including physical
examination, radiological and laboratory investigations and then
proceeded to bipolar eTURBT using mushroom loop electrode.Tumour specimens were sent for histopathological examination,
which was carried out in pathology department, Faculty of Medicine.
Bipolar eTURBT technique showed favorable periaoperative
outcomes with the average enucleation time was 23.11 min and average
operative time was 37.01 min, No bladder perforation occurred,
Obturator nerve reflex occurred only in 3 cases, haemoglobin drop
ranged between 0-1.6 gm/dl with a mean 0.3 gm/dl. There was no need
for blood transfusion at all, and postoperative irrigation was needed
only in seven cases (11%).
Histopathological examination revealed TCC in all patients. All
specimens contained bladder detrusor muscle with the pathological
staging was pTa in 20 patients (31.74%), pT1 in 34 patients (53.96%),
pT2a in 8 patients (12.69%) and pT2b in one patient (1.58%). The
random biopsies performed from tumour bed after resection revealed a
residual tumour in only two cases of the 9 patients with T2, and all
margins were examined and proved to be free from any malignant cells.
Till the end of our study, taken into consideration the limitations
of our study with emergence of COVID-19 pandemic, only 33 patients
(52.38 %) underwent follow up cystoscopy once or twice:
1- Seven cases with pTaLG underwent follow up cystoscopy after 3
months; all were negative for residual tumour or recurrence.
2- Three cases with pTaHG underwent follow up cystoscopy at 3 and
6 months; all were negative for residual tumour or recurrence.
3- Twenty-three cases with pT1 underwent follow up cystoscopy at 3
and 6 months; 4 cases (12%) showed recurrence, 3 at first and one
at second follow up cystoscopy, all were pT1HG. All 4 cases were
advised for radical cystectomy vs. bladder-preservation strategies.