Enhancing the quality of transurethral resection: The importance of a complete turb and the en-bloc resection

Abstract

Trans-Urethral Resection of Bladder (TURB) is one of the first endoscopic procedures executed by training residents, but the limits of classical TURB has always to be considered, i.e.: risk of tumor seeding, incomplete resection, thermal damage of specimen's margin, and, above all, the absence of DM. As a matter of fact, being a senior surgeon, the use of both “Bladder Diagram” and “Bladder Tumour Checklist” may help to overcome these limits, performing a “Good-quality TURB”. The “En-Bloc Resection of Bladder Tumour” (ERBT) may additionally overcome these limits, representing the best surgical technique to perform a “Good-quality TURB”, also because TURB and ERBT do not differ significantly regarding peri-operative morbidity. Nevertheless, ERBT requires specific instrumentation and dedicated surgeon. In this context, a specific teaching program, consisted in the presence of a consultant physician during all TURB performed by residents, the institution of a video-TURB archive for revisions, and weekly multidisciplinary discussion meetings between urologists and genito-urinary pathologist may significantly contribute to perform a “Good Quality TURB”.