Transurethral Resection of Bladder Tumor Using an Endoscopic Snare

Abstract

Introduction:

Resecting large pedunculated bladder tumors can be challenging and time consuming, especially if the tumor is located on the dome or anterior wall. We present our step-by-step process of transurethral resection of bladder tumor using an endoscopic snare (TURBTS).

Methods:

We use a 22.5F rigid cystoscope with a 30°/70° lens. The endoscopic snare we use is either a medium oval (27 mm) flexible or a large oval (30 mm) flexible polypectomy snare. Given monopolar electro cautery is used for the procedure, the patient has to be grounded. We use 10 W of pure cut energy to transect the stalk of the tumor and 30 W of energy for coagulation after removal of the tumor. Our criteria for performing a TURBTS was a papillary pedunculated tumor, tumors that appear low grade appearing in nature, patients with a negative urine cytology, and tumor size <8 cm. We typically perform a biopsy of the tumor base using a biopsy forceps or a resectoscope to ensure a thorough resection.

Results:

After institution review board approval, 49 consecutive patients underwent a TURBTS between 2008 and 2016. There were 20 female and 29 male patients. Median follow-up was 29 months (interquartile range [IQR] 9–43 months). Median age was 70 years (IQR 60–79). Median procedure time was 32 minutes (IQR 23.5–50.5). Median procedure time per tumor was 24 minutes (IQR 15–34.5). Median number of tumors treated per patient was 1 (IQR 1–2) and median tumor size was 3 cm (IQR 2–5 cm). Muscle was obtained in 71% (35/49) of patients. There were no immediate or long-term complications after TURBTS. Intravesical chemotherapy was administered in 84% (41/49) of patients. Tumor recurrence occurred in 34.7% (17/49) of patients.

Conclusion:

TURBTS of bladder tumor using an endoscopic snare is a safe and feasible procedure. TURBTS may be an additional armamentarium for a urologist to safely resect pedunculated tumors.

Runtime of video: 4 mins 13 secs