Bladder Cancer

Bladder Cancer

Transurethral Resection of Bladder Tumors

The transurethral resection of bladder tumors (TURBT) is truly one of the earliest minimally invasive surgical techniques. Although most urologist and urology residents are very adept at the technique, it has been little over 70 years since the instrumentation was developed to excise bladder tumors transurethrally. Prior to this era, large bladder tumor were excised via open incisions and often associated with multiple complications. Today, open tumor resections are rarely, if ever, performed.

Tips and Tricks for BCG Administration

BCG, an attenuated mycobacterium developed as a vaccine for tuberculosis, has been shown to have significant anti-tumor activity in patients with non-muscle invasive bladder cancer, and is the most effective intravesical agent at reducing recurrence and disease progression for patients with non-muscle invasive bladder cancer with high risk features (high grade disease, lamina propria involvement, carcinoma in situ)1-5. BCG is stored in refrigeration and reconstituted from a lyophilized powder.

Radical Cystectomy for Urothelial Carcinoma of the Bladder

It has been estimated that in 2010, there were more than 70,000 new cases of bladder cancer diagnosed in the United State, with more than 14,000 cancer specific deaths1. While approximately 70-80% present with non muscle invasive disease, 20% of these patients will be refractory or intolerant to intravesical therapies and another 10-30% of these patients will ultimately progress to muscle invasive disease2.

Emerging Intravesical Therapies for Non Muscle Invasive Urothelial Carcinoma

Although BCG is the reference standard for high risk non-muscle invasive bladder cancer (NMIBC), up to one third of patients recur, and a substantial number of patients progress to muscle invasive disease1. In addition, use of BCG is limited due to local or systemic toxicity in approximately 20% of patients. As a result, use of alternative intravesical agents has sparked significant interest in patients that are intolerant to BCG or not candidates for cystectomy due to competing risks.