Introduction: Bladder cancer is the fourth most frequently diagnosed malignancy in males and the 12th most common malignancy in females. Transurethral resection of bladder tumor (TURBT) remains the mainstay of diagnosis and initial treatment of bladder neoplasms. TURBT is performed conventionally with an electrocautery loop. The piecemeal resection specimens are inappropriate for tumor pathological evaluation because of poor anatomic orientation and evaluation of the pathological depth is not necessarily accurate. Also, tumor cells are scattered as the tumor is fragmented so that the possibility of implantation cannot be excluded. The objective of this study is to optimize the surgical method of transurethral bladder tumor resection.
Methods: 38 patients with non-muscle invasive bladder cancer received transurethral accurate resection of the tumor with a novel ß electrode with a radiofrequency energy platform. Normal bladder mucosa 0.5 to 1 cm from the tumor base was marked with the tip of ß electrode with an electrocautery energy. The needle of the ß electrode was insert into the submucosa, and tissue of the bladder wall was pulled towards the midline of the bladder, followed by electro-cutting. Tumor blood vessels were cauterized with the needle tip. After en bloc resection of the tumor bulk, a novel ß basket, which could be opened and trapped the tumor in bladder, was introduced into the bladder to retrieve the tumor en bloc or sub-en bloc.
Results: Tumors exceeded T2 stage or tumors with a maximum diameter of less than 1 cm were excluded. 38 patients underwent accurate transurethral radiofrequency resection of bladder tumors, and a total of 47 tumors were removed. The maximum diameter of the tumor is 2.4cm (range from 1 to 5cm). Tumors less than 3cm could be retrieved through the resection sheath or be taken out with the ß basket. 12 tumors with a maximum diameter of >3cm were divided into 2-3 large pieces by the ß basket and then taken out. During the operation, there was no obturator nerve reflex, no bladder perforation or urine extravasation. The intraoperative bleeding was less than 2ml in every patient. The bladder was flushed with normal saline for 24 hours post operation. Postoperative pathology showed Ta in 27cases and T1 in 11 cases. No second TURBT was performed in this group. No operative complications occurred. All patients received intravesical irrigation of BCG or chemotherapy agent periodically. 2 patients had tumor recurrence in the bladder during the mean follow-up of 8.7 months (range from 3 to 11 months).
Conclusions: A novel ß electrode was used to remove the tumor during accurate transurethral radiofrequency resection of bladder tumors. There are several advantages of this novel method. First, the blood supply of the tumor was occluded to avoid bleeding. Second, the obturator nerve reflex could be prevented completely and local nerve blockage was not necessary. Third, accurate radiofrequency resection of bladder tumor improved the resection quality and the en bloc resection helped make accurate TNM stage which was significant for postoperative treatment strategy.
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