28 Bladder dome air bubbles in TURBT: is there any benefit from removing the air bubble at TURBT?

Abstract

Introduction: The recurrent nature of superficial bladder cancer is currently explained by two theories – field change and implantation, with good evidence supporting each theory. Many recurrent tumours occur at the dome of the bladder. It is postulated at transurethral resection of superficial bladder cancer (TURBT) tumour fragments are held within the air bubble that forms at the dome and lead to recurrent tumours. In a pilot study we have shown there are viable tumour cells at the air‐bubble fluid interface. In this study we examine the effects of removing the air‐bubble on reducing tumour fragments in voided urine following TURBT and its effect on tumour recurrence. We have used urine cytology as a surrogate marker of the likelihood of tumour recurrence. Positive urine cytology at day 3 following TURBT has been associated with increased incidence of recurrent tumours.Method: All patients having a TURBT for primary or recurrent superficial bladder cancer (Ta, T1 and CIS) were entered prospectively. Two groups were examined – group one had a standard TURBT and group two had removal of the air bubble and macroscopic tumour fragments at the end of standard TURBT. All patients then had a voided urine specimen on day 1 postTURBT. The voided urine had quantitative analysis performed. Patients were then followed for tumour recurrence with cystoscopy surveillance.Results: Formal results to be tabulated.Conclusion: Removal of the air bubble at the time of TURBT does reduce the incidence of tumour cells in voided urine at day 1 postTURBT.