Does En-bloc transurethral resection of bladder tumor give a better yield in terms of presence of detrusor muscle in the biopsy specimen?

AIMS: Detrusor muscle in initial transurethral resection of the bladder tumor (TURBT) may not be found in up to 50% of the cases. This study was done to assess the safety, feasibility and yield of detrusor muscle on en- bloc TURBT using a conventional electrocautery loop.

MATERIALS AND METHODS: Patients with bladder tumor of size 2-4 cm, from September 2007 to August 2010, who had en-bloc TURBT, were compared with patients who had conventional resection for the presence of detrusor muscle in the biopsy specimen on an initial resection. Tumor size was calculated on ultrasonography or contrast enhanced computerized tomography scan. Tumor with pedunculated base, more than 4 cm in size and tumor with hydroureteronephrosis were excluded. Conventional electrocautery loop was bent to 45° and periphery of the tumor was marked first and then the whole tumor was resected en bloc. The free-lying tumor was then cut into two or three pieces in the bladder for retrieval. Statistical analysis was done using SPSS software Version 13.

STATISTICAL ANALYSIS USED: Statistical analysis was done using Pearson chi square test and P value of <.05 was considered significant.

RESULTS: A total of 25 patients in the control arm (with conventional TURBT) were compared with 21 patients who had en-bloc TURBT. En-bloc TURBT did not result in bladder perforation as vision was clear due to better hemostasis. Twenty of 21 (94.4%) patients had detrusor muscle but only 15 of 25 (60%) patients in the control arm had detrusor muscle on histopathological examination (P.001)

CONCLUSIONS: En-bloc TURBT is safe and gives well-controlled resection of the whole tumor due to better visualization. Yield of detrusor muscle present in the specimen is significantly better with en-bloc TURBT.