Transurethral resection of bladder cancer - The basis for diagnosis and management

Transurethral resection of one or more bladder tumours can be a challenging procedure to perform accurately and safely. The goal is to remove the entire visible tumour and provide a specimen to the pathologist to allow them to make an accurate diagnosis. This requires care in performing the resection so that the specimen has minimal cautery artefact and contains sufficient material to allow the pathologist to determine whether the specimen contains cancer and if so, the histological type, depth of invasion, presence of lymphovascular invasion, presence of carcinoma in situ, etc. There is ample evidence that many resections are incomplete and thus there is room for improvement. This article reviews some of the principles for performing this procedure with an emphasis on the fact that it is not always easily performed and experience is required to perform it well. New techniques have been introduced recently in an attempt to improve the goal of removing the whole tumour.