Bladder cancer is the 5th commonest cancer in the UK and up to 85% will present with superficial disease. Considering the principals of oncological surgery, best practice is to excise a tumour whole with clear circumferential margins. The inherent flaw of transurethral resection (TUR) is tumour fragmentation. However, high quality resection and immediate single-dose chemotherapy decreases recurrence rates and disease progression for superficial disease. TUR is the current gold standard for diagnosis and treatment of superficial bladder cancer. The associated morbidity is usually low.
Good quality TUR can be difficult with tumours in diverticula, over ureteric orifices, on the dome/anterior/posterior wall or if obturator nerve stimulation occurs. As such technical tips are provided.
Modern TUR relies on white light. The use of fluorescence cystoscopy will almost certainly increase, challenging white light TUR as the current gold standard. Furthermore, the development of bladder cancer urinary markers may provide a cost effective and non-invasive means of determining the frequency of surveillance cystoscopy.
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