TURBT Flashcards
prostatic urethra biopsy
Bladder neck tumour
CIS present or suspected
Positive cytology with no tumour in bladder
Abnormalities of prostatic urethra visible
when to do bladder mapping
During follow-up in patients with positive cytology and no visible tumour in the bladder, mapping-biopsies or PDD-guided biopsies (if equipment is available) and investigation of extravesical locations (CT urography, prostatic urethra biopsy) are recommended.
Biopsies from normal-looking mucosa (trigone, bladder dome, and right, left, anterior and posterior bladder walls) are recommended when cytology is positive or when high-risk exophytic tumour is expected (non-papillary appearance).
re do turbt NICE
6 weeks if
No detrusor
High risk NMIBC asap
how to perform resection
Perform resection in fractions including the
exophytic part of the tumour,
the underlying bladder wall with the detrusor muscle and
the edges of the resection area for tumours > 1 cm in diameter
how to do prostatic biopsy
Take the biopsy from abnormal areas in the prostatic urethra and from the precollicular area (between 5 and 7 o’clock position) using a resection loop.
In primary non-muscle-invasive tumours when stromal invasion is not suspected, cold-cup biopsy with forceps can be used
PDD
high detection rate
recurrrence reduction
PDD (Fluorescence cystoscopy) is performed using ultraviolet light after intravesical instillation of 5-aminolaevulininc acid(ALA) or hexaminolaevulinic acid (HAL).
PDD had higher sensitivity than whitelight endoscopy in the pooled estimates for analyses at both the patient-level (92% vs.71%) and biopsy-level (93% vs.65%).
A meta-analysis reported in HAL arms an increase in detection of tumour lesions across all risk groups and an absolute reduction of < 10% in recurrence rates within 12 months.
• SR showed 20% higher detection rate in NMIBC and 39% increase in diagnosis of CIS compared to white light cystoscopy
aims re do turbt 3
recurrence-free survival
improve outcomes after BCG treatment
and provide prognostic information
redo turbt persistant disease
Persistent disease after resection of T1 tumours has been observed in 33-55% of patients.
Persistent disease after Resection of TaG3 tumour in 41.4%
higher stage disease on re do
The likelihood that muscle-invasive disease is detected by second resection of initially T1 tumour ranges from 4-25%, and it increases to 45% if there was no muscle in the initial resection.
Role of Mitomycin C.
Anti-tumour antibiotic
Causes DNA cross linking in bladder tumour cells
S phase specific
How do you give it?
What is the evidence for MMC?
What are the side effects?
40mg in 40ml of saline
EAU • If given, administer a single immediate instillation of chemotherapy within 24 hours after TURB, for 1-2 hours duration
MMC sylvester
In a SR and individual patient data meta-analysis of 2,278 eligible patients SI reduced the 5-year recurrence rate by 14%, from 59% to 45%.
NNT 7 to prevent recurrence in 5 years, original 12 ARR
pathology report
The pathological report should specify tumour location, tumour grade, depth of tumour invasion, presence of CIS, and whether the detrusor muscle is present in the specimen.
The pathological report should specify the presence of LVI or unusual (variant) histology.
purpose of MDT
Why risk stratify in bladder cancer: - ‘PREDICTING DISEASE RECURRENCE AND PROGRESSION’.
- To stage / grade the tumour
- To ‘RISK STRATIFY’ the tumour
- For the purpose of ‘PROGNOSIS’
