Reply

Abstract

The intent of our article was not to describe in detail the technique of accomplishing a complete endoscopic resection of all bladder tumors, as I have coauthored chapters 1 Shelfo S.W. Brady J.D. Soloway M.S. Transurethral resection of bladder cancer: the mainstay of treatment. Atlas Urol Clin North Am. 1997; 5: 1-14 Google Scholar , 2 Dudak S.D. Soloway M.S. Video resection techniques in the diagnosis and management of bladder tumors. in: McGuire E.J. Bloom D. Catalona W.J. Advances in Urology. Vol 9. Mosby-Year Book, Chicago, IL1996: 11-23 Google Scholar addressing some of the excellent points indicated by Dr Herr in his editorial comments. Rather this article aimed to stress that, for a variety of reasons, a high percentage of patients with Ta and T1 bladder tumors do not undergo a complete resection. One would have to assume, possibly incorrectly, that a urologist performing a TUR of bladder tumors would try to remove all tumors. The fact that macroscopic tumor remains in the bladder within 4 weeks before resection indicates that this procedure is not easily performed. This might be because tumors are located in a region of the bladder that is difficult to visualize, the bladder is thin and the surgeon is concerned about perforation, or the equipment is substandard and does not allow a successful procedure. Attention to detail is required. Among the requirements for success in the outcome of patients with Ta−T1 bladder tumors is accurate staging as well as removal of all evident tumor before proceeding with intravesical therapy, or a bladder preservation strategy for T2 tumors. In either case, there is agreement that the results are far better when all tumors have been eradicated before embarking on prophylaxis or treatment. As Dr Herr correctly emphasizes, the guideline for a reTUR for high grade T1 and for some high grade Ta tumors is to help ensure accuracy in staging. A 3 month delay in the proper management of high grade bladder cancer can be catastrophic. Editorial CommentUrologyVol. 75Issue 2PreviewThe aim of transurethral resection (TUR) is to resect all nonmuscle-invasive bladder tumors, but surgery as currently practiced fails in a significant proportion of patient's resection. Incomplete TURs are partly due to the number, size, location, and extent of bladder neoplasm, and in part due to the lack of experience, skill, and diligence of the surgeon.1 Confirming these observations, the authors provide guidelines to improve the quality of TUR of bladder tumors. Their recommendations are too general and lacking in detail, however, to be useful in individual cases. Full-Text PDF