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Background Methods Results Conclusions Photodynamic diagnosis (PDD)‐assisted transurethral resection of bladder tumors (TURBT) has emerged as a promising complementary tool to white light (WL) cystoscopy, potentially improving cancer detection and replacing conventional mapping biopsies. This study aimed to investigate the diagnostic accuracy of PDD by anatomical locations in mapping biopsies through lesion‐based analysis.PDD and WL findings were prospectively recorded in 102 patients undergoing mapping biopsies and PDD‐assisted TURBT using oral 5‐aminolevulinic acid. We evaluated 673 specimens collected from flat tumor or normal‐looking lesions on WL cystoscopy, after excluding 98 specimens collected from papillary or nodular tumors.Among the 673 lesions, cancer was detected in 110 (16%) by lesion‐based analysis. PDD demonstrated significantly higher sensitivity (65.5% vs. 46.4%, p < 0.001) and negative predictive value (92.5% vs. 89.5%, p < 0.001) compared to WL. The sensitivity of PDD findings varied by location: posterior (100%), right (78.6%), dome (73.3%), left (70.6%), trigone (58.8%), bladder neck (41.7%), anterior (40.0%), and prostatic urethra (25.0%). Incorporating targeted biopsies of specific locations (bladder neck, anterior, and prostatic urethra) into the PDD‐guided biopsies, regardless of PDD findings, significantly increased the overall sensitivity from 65.5% to 82.7% (p = 0.001).This study first demonstrated the detection rate of location‐specific mapping biopsies using PDD, revealing difficulties in accuracy assessment in areas susceptible to tangential fluorescence. While PDD‐guided biopsy improves cancer detection compared to WL cystoscopy even for flat tumors or normal‐looking lesions, more careful decisions, including mapping biopsies, may be beneficial for an assessment in these tangential areas. [ABSTRACT FROM AUTHOR]

In the management of non‐muscle invasive bladder cancer (NMIBC), disease progression and long‐term control are determined by the intensity of delivered treatment and surveillance and the cancer cells' biological nature. This requires risk stratification–based postoperative management, such as intravesical instillation of chemotherapy drugs, Bacillus Calmette–Guérin (BCG), and radical cystectomy. Advancements in mechanical engineering, molecular biology, and surgical skills have evolved the clinical management of NMIBC. In this review, we describe the updated evidence and perspectives regarding the following aspects: (1) advancements in surgical concepts, techniques, and devices for transurethral resection of the bladder tumor; (2) advancements in risk stratification tools for NMIBC; and (3) advancements in treatment strategies for BCG‐treated NMIBC. Repeat transurethral resection, en‐bloc transurethral resection, and enhanced tumor visualization, including photodynamic diagnosis and narrow‐band imaging, help reduce residual cancer cells, provide accurate diagnosis and staging, and sensitive detection, which are the first essential steps for cancer cure. Risk stratification should always be updated and improved because the treatment strategy changes over time. The BCG‐treated disease concept has recently diversified to include BCG failure, resistance, refractory, unresponsiveness, exposure, and intolerance. A BCG‐unresponsive disease is an extremely aggressive subset unlikely to respond to a rechallenge with BCG. Numerous ongoing clinical trials aim to develop a future bladder‐sparing approach for very high‐risk BCG‐naïve NMIBC and BCG‐unresponsive NMIBC. The key to improving the quality of patient care lies in the continuous efforts to overcome the clinical limitations of bedside management. [ABSTRACT FROM AUTHOR]

Objectives: Accurately predicting of progression is important for patients with non‐muscle‐invasive bladder cancer (NMIBC). We previously reported that bladder neck involvement (BNI) was significantly associated with progression of NMIBC. In this study, we evaluated the prognostic significance of the detailed BNI location in NMIBC patients. Methods: We retrospectively reviewed 651 patients diagnosed with primary NMIBC at a single center between 2000 and 2018. Using the detailed BNI location, patients were divided into the following three groups: dorsal BNI (BNId; 4 to 8 o'clock position), ventral BNI (BNIv; 8 to 4 o'clock but not 4 to 8 o'clock position), and non‐BNI group. Both time to progression to muscle‐invasive disease and distant metastasis was compared among the three groups. A prognostic model was developed and its discriminative ability was evaluated. Results: Dorsal bladder neck involvement and BNIv were observed in 43 (6.6%) and 36 (5.5%) patients, respectively. During a median follow‐up of 61 months, 35 (5.4%) patients progressed. The cumulative incidence at 5 years was 12%, 0%, and 5.0% in BNId, BNIv, and non‐BNI groups, respectively. On multivariate analysis, BNId was a significant and independent risk factor for progression, tumor stage pT1, and histologic grade G3. One point was assigned to each factor, and patients were classified into four well‐stratified prognostic groups based on the total score. Conclusion: Dorsal bladder neck involvement was an independent and significant risk factor for progression in primary NMIBC. Our simple and practical prognostic model including BNId is easy to use and may help selecting the optimal treatment and its timing. [ABSTRACT FROM AUTHOR]

Objectives: To examine the long‐term outcomes of transurethral resection of the prostate. Methods: We retrospectively collected the data of patients who had undergone transurethral resection of the prostate before December 2010. Patients had been evaluated by urodynamics and the International Prostate Symptom Score preoperatively, and they were re‐evaluated by using the International Prostate Symptom Score at the minimum 7 years after transurethral resection of the prostate. Patients who received any treatments to improve voiding symptoms were defined as having a relapse of voiding dysfunction. The Schäfer nomogram was used to assess the degree of obstruction and detrusor contractility. We assessed the change in International Prostate Symptom Score over time depending on obstruction (Schäfer grade 3–6) versus no obstruction (Schäfer grade 0–2), and normal detrusor contractility (strong and normal) versus detrusor underactivity (weak and very weak). Relapse rates of voiding dysfunction were determined using the Kaplan–Meier method. Results: A total of 39 patients were included. The mean age at transurethral resection of the prostate was 69.8 years, and the mean observation period after transurethral resection of the prostate was 114 months. During the observation period, eight patients (21%) were categorized as relapse of voiding dysfunction and the mean time to relapse was 4.2 years. Patients categorized as no obstruction or detrusor underactivity had a higher recurrence rate of voiding dysfunction with a statistical significance between those with versus without obstruction. Except for patients with relapse of voiding dysfunction, improvement of the International Prostate Symptom Score was maintained over a period of 10 years after transurethral resection of the prostate. Conclusions: Favorable long‐term symptomatic outcome after transurethral resection of the prostate is likely in patients with urodynamic obstruction. Patients without urodynamic obstruction are likely to have a relapse of voiding symptoms and require additional treatments in the long term. [ABSTRACT FROM AUTHOR]

Objective: To confirm the reproducibility of the effectiveness and safety in photodynamic diagnosis of non‐muscle‐invasive bladder cancer using 5‐aminolevulinic acid in a prospective multicenter non‐randomized phase III trial. Methods: A total of 61 patients with primary or recurrent non‐muscle‐invasive bladder cancer were prospectively enrolled from five hospitals between May 2015 and March 2016. 5‐Aminolevulinic acid (20 mg/kg) was orally administered 3 h before transurethral resection of bladder tumors using white light or fluorescent light. Of 60 evaluable patients, 511 specimens were obtained from tumor‐suspicious lesions and normal‐looking mucosa. The primary end‐point was sensitivity. The secondary end‐points were specificity, positive and negative predictive values, and safety. Results: The sensitivity of the fluorescent light source (79.6%) was significantly higher (P < 0.001) than that of the white light source (54.1%). In total, 25.4% (46/181) of tumor specimens were diagnosed as positive with only the fluorescent light source. In nine (15%) of 60 patients, the risk classification and recommended treatment after transurethral resection of bladder tumors were changed depending on the additional types of tumor diagnosed by the fluorescent light source. The specificity of the fluorescent light versus white light source was 80.6% versus 95.5%. No grade 4–5 adverse event was noted. Hypotension and urticaria were severe adverse events whose relationship to oral 5‐aminolevulinic acid could not be excluded. Conclusions: These findings confirm the diagnostic efficacy and safety of photodynamic diagnosis with 20 mg/kg of oral 5‐aminolevulinic acid, and show that transurethral resection of bladder tumors with a fluorescent light source using oral 5‐aminolevulinic acid is well tolerated. [ABSTRACT FROM AUTHOR]

Objectives To investigate the efficacy and complications of controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction. Methods A total of 59 patients who were diagnosed with female primary bladder neck obstruction by urodynamic examination underwent surgical procedures at Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China, between March 2010 and March 2014. For all patients, neurogenic, anatomical and dysfunctional voiding causes of bladder outlet obstruction had been excluded. Perioperative and follow-up data, including operative time, maximum urine flow rate, residual urine volume, International Prostate Symptom Score and Quality of Life Score, were prospectively investigated. Results All of the operations were completed uneventful. The median operative time was 15 ± 8 min (range 10-22 min). No massive hemorrhage or infection was reported. Follow-up data were available for 59, 59, and 57 of the patients at 1, 6 and 12 months postoperatively, respectively. The mean maximum urine flow rate increased from 7.2 ± 3.9 mL/s preoperatively to 26.1 ± 5.2 mL/s postoperatively. The mean residual urine volume decreased from 162 ± 75 to 20 ± 7 mL. The mean International Prostate Symptom Score decreased from 24.5 ± 7.2 to 5.5 ± 3.6. The mean Quality of Life Score decreased from 5.4 ± 1.7 to 1.9 ± 1.1. All of the differences between the preoperative and postoperative values were significant ( P < 0.001). Conclusions The novel technique described here shortens the length of the urethra to 2.5 cm, which both released the obstruction and maintained continence. The results of the present preliminary study show that this method represents a safe and effective treatment for female primary bladder neck obstruction. [ABSTRACT FROM AUTHOR]

To date, no tool exists to predict pT0 at radical prostatectomy (RP) in patients with T1a-T1b prostate cancer (PCa) after surgery for benign prostatic hyperplasia (SxBPH). We aimed to fill this gap by developing a user-friendly flowchart to assist urologists when incidental PCa is diagnosed and a clinical decision is required. We analyzed 158 T1a-T1b prostate cancers patients who underwent RP between 1996 and 2009. A risk stratification tool was developed applying the tree modeling technique of classification and regression tree analysis (CART) and relying on all the available pre-RP characteristics (age, prostate-specific antigen [PSA] before SxBPH, PSA after SxBPH, cT1a-T1b stage, prostate volume and Gleason sum at SxBPH). Then, the accuracy of the proposed model using 200 bootstrap resamples for internal validation was calculated. A total of 95 patients (60.1%) were stage T1a, and 63 (39.9%) were stage T1b. The median values of PSA before and after SxBPH were 4.2 and 1.1 ng/mL, respectively. A total of 22 patients (13.9%) showed no residual tumor (pT0) at RP. The CART analyses identified three groups at risk of having residual disease at RP: (i) PSA after SxBPH > 1.0 ng/mL (pT0 prevalence: 3.8%); (ii) PSA after SxBPH < 1.0 ng/mL and PSA before SxBPH > 2.0 ng/mL (pT0 prevalence: 14.8%); and (iii) PSA after SxBPH < 1.0 ng/mL and PSA before SxBPH < 2.0 ng/mL (pT0 prevalence: 42.3%). The accuracy of the proposed model was 77.1%. Clinical stage (T1a vs T1b) was not associated with pT0 ( P = 0.4). Clinical stage (T1a vs T1b) assessment does not help in predicting pT0 cases. An accurate and clinically useful flowchart to predict pT0 at RP after incidental prostate cancer diagnosis is provided herein. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively compare late toxicity of conventional-dose three-dimensional conformal radiation therapy (3D-CRT) and high-dose intensity-modulated radiation therapy (IMRT) for prostate cancer. Methods: A total of 340 patients with T1-3 prostate cancer were treated with 3D-CRT ( n = 228) and IMRT ( n = 112). The median follow-up time was 5.9 years and 3.0 years, respectively. The prescription dose was 70 Gy for 3D-CRT and 78 Gy for IMRT. Late gastrointestinal (GI) and genitourinary (GU) toxicities were graded according to the Fox Chase modification of the Radiation Therapy Oncology Group and Late Effects Normal Tissue Task Force criteria. Results: There was no difference between 3D-CRT and IMRT in the incidence of GI and GU toxicity at 3 years. On multivariate analysis, transurethral resection of prostate/open transvesical prostatectomy (TURP/TVPE) for benign prostatic hyperplasia, carried out before radiotherapy, significantly increased the risk of Grade ≥2 GU toxicity (risk ratio 1.88). Among patients who experienced TURP/TVPE, the 5-year actuarial likelihood of Grade 2–3 urinary incontinence was 23%, compared with 9% for those without prostate surgery ( P = 0.01). Conclusions: Tolerance of 3D-CRT and IMRT was similar, despite the use of high radiation dose with IMRT. Previous TURP/TVPE increased the risk of GU toxicity. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to investigate risk factors for intravesical recurrence in patients with superficial bladder cancer without concomitant carcinoma in situ (CIS). Methods: In this series, we analyzed data from patients with newly diagnosed superficial Ta or T1 transitional cell carcinoma (TCC) of the bladder without concomitant CIS who underwent complete transurethral resection (TUR) without any adjuvant intravesical instillation therapies. Multivariate analysis was used to determine significant risk factors affecting intravesical recurrence after TUR. Differences in clinicopathological features between primary and recurrent tumors were also characterized. Results: Among 341 patients undergoing TUR of Ta or T1 bladder cancer, 187 diagnosed as having concomitant CIS and/or treated with adjuvant intravesical therapy were excluded, and the remaining 154 were evaluated. Intravesical recurrence was detected in 64 of the 154 patients, showing a 5-year recurrence-free survival rate of 58.3%. Among several factors examined, only tumor size was significantly associated with intravesical recurrence. Multivariate analysis identified tumor size as an independent predictor for intravesical recurrence irrespective of other parameters including age, gender, multiplicity, growth pattern, grade and stage. Recurrent tumors were significantly smaller and of a lower grade and lower stage than primary tumors, despite the absence of differences in growth pattern and the multiplicity between them. Conclusions: These findings suggest that primary tumor size could be used as a potential risk factor for predicting intravesical recurrence following TUR of superficial TCC of the bladder without concomitant CIS, and that the pathological characteristics of recurrent tumors are more favorable than those of primary tumors. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility of discarding antimicrobial prophylaxis (AMP) for transurethral resection of bladder tumor (TURBT). Methods: One-hundred and sixty-two patients undergoing TURBT, with no risk factors for infectious complications were included in this prospective study between April 2006 and April 2008. Forty-four patients received single oral dose of 200 mg levofloxacin for AMP (LVFX group), and the remaining 118 received no AMP (no AMP group). Rates of postoperative infectious complications were compared between the two groups. Results: There was no significant difference between the two groups in terms of baseline characteristics, including age, sex, history of TURBT, number of tumors, duration of operation and days of catheterization. Symptomatic urinary tract infections (UTIs) occurred in four patients (3.4%) in the no AMP group and one patient (2.3%) in the LVFX group ( P = 0.61). All patients having UTIs were men, and were successfully treated by immediate administration of antibiotics. No patients developed extra-urinary tract infections. Conclusions: Based on our findings, AMP for TURBT in patients with no risk factors for infectious complications is not necessary. The use of antibiotics might be deferred until postoperative infections develop. [ABSTRACT FROM AUTHOR]

Abstract Pheochromocytoma of the urinary bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We report, herein, the case of a 62-year-old woman with bladder pheochromocytoma. The patient presented with a bladder tumor that was incidentally found by computed tomography (CT) without the triad of sustained hypertension, hematuria and postmicturitional syncope. Cystoscopy revealed a yellowish submucosal tumor in the right lateral wall of the bladder. Treatment consisted of transurethral resection in the initial diagnosis of bladder tumor. A definitive diagnosis was made postoperatively upon pathological examination. The patient has been followed up for 12 months and has shown no recurrence. [ABSTRACT FROM AUTHOR]

Transurethral resection is usually performed using an all-in-one drape with a fluid collection pouch, drainage port and hose. Gravity drainage of irrigation fluid through the hose is often hampered, resulting in fluid retention in the pouch. We applied a siphon principle to facilitate fluid drainage by making a U-shaped bend near the distal end of the hose, using an adhesive tape, and hooking the distal end of inverted U shape on the edge of bucket placed on the floor. When the hose is filled with irrigation fluid up to the crest of the siphon, fluid flow driven by atmospheric pressure continues until the pouch is evacuated. Repriming and restarting occur automatically throughout the operation. This simple device has virtually eliminated fluid retention in the pouch and proved to be especially useful in transurethral prostatectomy, which requires a large amount of irrigation fluid. [ABSTRACT FROM AUTHOR]

Abstract Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique. [ABSTRACT FROM AUTHOR]

Abstract Background : A prospective study was conducted to determine whether transurethral resection of the prostate (TURP) facilitates detection of prostate cancer that is missed with systematic sextant biopsies associated with transition zone (TZ) biopsies. Methods : A total of 139 consecutive patients underwent transperineal TZ biopsies of each lobe in addition to a transrectal systematic sextant peripheral zone (PZ) biopsy. Patients whose biopsies were negative for cancer received TURP for relief of lower urinary tract obstruction when indicated. Results : Cancer was detected in biopsy specimens of 40 patients. Of these cancers, 18 originated in the PZ alone and 22 were located both in the TZ and the PZ. No cancers were detected in the TZ alone. Of 99 patients who were proven not to have cancer by the biopsies, 18 were indicated for TURP. Five of these patients (28%) had cancer in the resected tissues. All cancers were clinically organ confined and their Gleason sum scores were 2–5. Cancer-positive chips accounted for less than 10% of all resected specimens. Of the 66 patients with negative biopsies and without indication for TURP, four (6%) were revealed to have an elevation of the serum PSA level during follow up. They were later proven to have cancer by a second biopsy. Conclusion : Routine use of TZ biopsy is not warranted for detection of cancer. Transurethral resection of the prostate can detect cancers in patients with negative PZ and TZ biopsies. However, cancers detected by TURP may not always be clinically significant and only four of 66 patients who were not indicated for TURP and received a close follow up were later found to have cancer, although their follow-up period was short. Thus, it still remains to be elucidated whether TURP is necessary for all patients with negative biopsies of the prostate. [ABSTRACT FROM AUTHOR]