Background: Conventional transurethral resection of urinary bladder tumour (TURBT) using a wire loop diathermy violates the basic principle of oncological surgery, i.e. dissection through normal tissue. However, in the en bloc technique, the tumour is removed as a single specimen. We compared the quality of specimen and recurrence rate at three months (first check cystoscopy) in both the en bloc and conventional resection techniques. Methods: The subject accrual was done from June 1st, 2017 till June 30th, 2019 at a tertiary care hospital. Patients with newly diagnosed bladder tumour, solitary or multiple ≤ 3cm were included in the study. Patients with carcinoma in situ, prior TURBT, or muscle-invasive bladder cancer were excluded. Eighty-two patients were available for final analysis, 41 in each group. Results: Mean age, gender ratio, tumour features (grade, stage, median number, and size) were comparable in the two groups.  Median Operative time [interquartile range- (IQR)] was 30 (25 – 39.5) minutes in the en bloc group as compared to 45 (33 – 63.5) minutes in the conventional group (p < 0.001). The detrusor muscle was seen at the base of the primary tumour in all 41 (100%) en bloc cases as compared to 23 (56 %) cases in the conventional group (p <0.001). Overall recurrence at the first surveillance cystoscopy was 17%, with an insignificant difference between the groups. Recurrence at primary site was 19.5% in conventional TURBT compared to en bloc resection (n = 1, 2.4%), (p = 0.013). Conclusion: En bloc resection decreases the recurrence rate at the primary site. En bloc TURBT is a safe technique, providing high-quality specimens for histopathological evaluation and reducing the need for the second TURBT.Keywords: En bloc TURBT; conventional TURBT; non-muscle-invasive bladder cancer; recurrence rate; detrusor muscle

Author Biographies

Muhibullah Bangash, Aga Khan University Hospital Karachi

Urology section Resident

Muhammad Hammad Ather, Aga Khan University Hospital Karachi

Professor, Urology Aga Khan University Hospital Karachi

Nasir Khan, Khyber Teaching Hospital, Peshawar.

Consultant Urologist,Khyber Teaching Hospital, Peshawar.

Shoaib Mohammad, Aga Khan University Hospital Karachi

Urology section Resident

Zeeshan Uddin, Aga Khan University Hospital Karachi

Histopathologist,Aga Khan University Hospital Karachi.


Sureka SK, Agarwal V, Agnihotri S, Kapoor R, Srivastava A, Mandhani A. Is en-bloc transurethral resection of bladder tumor for non-muscle invasive bladder carcinoma better than conventional technique in terms of recurrence and progression?: A prospective study. Indian J Urol 2014;30(2):144–9.

Colombel M, Soloway M, Akaza H, Böhle A, Palou J, Buckley R, et al. Epidemiology, staging, grading, and risk stratification of bladder cancer. Eur Urol Suppl 2008;7(10):618–26.

Farhan M, Muhammad NS, Ahmed J, Ather H. Frequency and predictors of recurrence of bladder tumour on first check cystoscopy-a tertiary care hospital experience. J Pak Med Assoc 2016;66(10):S125–130.

Donat SM. Evaluation and follow-up strategies for superficial bladder cancer. Urol Clin North Am 2003;30(4):765–76.

Maruniak N, Takezawa K, Murphy W. Accurate pathological staging of urothelial neoplasms requires better cystoscopic sampling. J Urol 2002;167(6):2404–7.

Cheng YY, Sun Y, Li J, Liang L, Zou TJ, Qu WX, et al. Transurethral endoscopic submucosal en bloc dissection for nonmuscle invasive bladder cancer: A comparison study of HybridKnife-assisted versus conventional dissection technique. J Can Res Ther 2018;14(7):1606–12.

Upadhyay R, Kapoor R, Srivastava A, Krishnani N, Mandhani A. Does En bloc transurethral resection of bladder tumor give a better yield in terms of presence of detrusor muscle in the biopsy specimen? Indian J Urol 2012;28(3):275–9.

Wolters M, Kramer MW, Becker JU, Christgen M, Nagele U, Imkamp F, et al. Tm: YAG laser en bloc mucosectomy for accurate staging of primary bladder cancer: early experience. World J Urol 2011;29(4):429–32.

Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: A global overview and recent trends. Eur Urol 2017;71(1):96–108.

Bhurgri Y, Bhurgri A, Hassan SH, Zaidi S, RahimA, Sankaranarayanan R, et al. Cancer incidence in Karachi, Pakistan: first results from Karachi cancer registry. Int J Cancer 2000;85(3):325–9.

Herr H, Donat S. A re-staging transurethral resection predicts early progression of superficial bladder cancer. BJU Int 2006;97(6):1194–8.

Herr HW, Donat MS. Quality control in transurethral resection of bladder tumors. BJU Int 2008;102(9 Pt B):1242–6.

Chen J, Zhao Y, Wang S, Jin X, Sun P, Zhang L, et al. Green‐light laser en bloc resection for primary non‐muscle‐invasive bladder tumor versus transurethral electroresection: a prospective, nonrandomized two‐center trial with 36‐month follow‐up. Lasers Surg Med 2016;48(9):859–65.

Dutta SC, Smith JA Jr, Shappell SB, Coffey CS, Chang SS, Cookson MS. Clinical under staging of high-risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol 2001;166(2):490–3.

Hurle R, Lazzeri M, Colombo P, Buffi N, Morenghi E, Peschechera R, et al. “En bloc” resection of nonmuscle invasive bladder cancer: a prospective single-center study. Urology 2016;90:126–30.



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