Surgical Management of Bladder Carcinoma

Rafael Carrion, MD, John Seigne, MB

Disclosures

Cancer Control. 2002;9(4) 

In This Article

The Role of Laser and Other Endoscopic Modalities

TUR of bladder tumors and transurethral resection of the prostate (TURP) use the same electrosurgical technology. Considerable progress has been made in developing new, less invasive therapies for benign prostatic hyperplasia in order to decrease the morbidity associated with TURP. Unfortunately, few of these technologies have been translated to the endoscopic management of bladder tumors. The neodymium:yttrium aluminum garnet (Nd:YAG) and holmium YAG laser have been used for the treatment of benign prostatic hyperplasia and bladder tumors. In general, lasers work effectively to destroy tumors. However, lasers are not useful in situations where pathologic assessment of the tumor is necessary. Because pathologic assessment is important in most circumstances surrounding the management of bladder cancer, these modalities have not flourished. Recently, a new device has been introduced that uses bipolar current for TUR, thus improving hemostasis and allowing the use of saline for electrosurgery. Our preliminary experience with this device suggests that the technology offers improvements with enhanced safety and decreased blood loss while allowing for adequate pathologic assessment.[14]

Several reports have suggested that the sensitivity of cystoscopy to detect dysplasia and carcinoma in situ can be improved by instilling 5-aminolaevulinic acid into the bladder and then examining protoporphyrin IX fluorescence under blue and white light. However, this technology has not spread beyond select research centers.[15,16]

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