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Current European Trends in Endoscopic Imaging and Transurethral Resection of Bladder Tumors

: Waldbillig, Frank; Hein, Simon; Grüne, Britta; Suarez-Ibarrola, Rodrigo; Liatsikos, Evangelos; Salomon, Georg; Reiterer, Alexander; Gratzke, Christian; Miernik, Arkadiusz; Kriegmair, Maximilian; Ritter, Manuel


Journal of endourology 34 (2020), No.3, pp.312-321
ISSN: 0892-7790
ISSN: 1557-900X
Journal Article
Fraunhofer IPM ()
endoscopic documentation; tumor visualization methods; cystoscopy; resection techniques

Purpose: The aim of this survey was to obtain an overview of current European standards in the endoscopic visualization and management of bladder tumors.
Methods: An online survey was launched in July 2018 for a duration of 4 months. It was distributed to all members of the European Association of Urology (EAU) and included 23 questions divided into 3 thematic sections: general information, white light cystoscopy (WLC) and imaging, and transurethral resection of bladder tumor (TURBT) techniques.
Results: Responses of 222 participants were included for analysis. The majority of physicians were between 30 and 40 years of age (48.2%, n = 107) and performed over 50 TURBT per year (52.2%, n = 115). Overall, 52.3% (n = 116) reported WLC findings in written form only, 23.8% (n = 53) added endoscopic footage, and 79.2% (n = 176) considered preliminary WLC/TURBT reports before performing a subsequent bladder intervention. About half of the participants (50.5%, n = 104) used additional tumor visualization methods (aTVMs), but aTVMs were utilized by a greater proportion of physicians from Western countries (58.1%, n = 90) compared with developing countries (20.0%, n = 7). Photodynamic diagnosis was the predominant aTVM technique employed (43.8%, n = 60). Bipolar current was the most common technique for TURBT (46.6%, n = 149). Most urologists in this study occasionally utilized techniques like resections in fractions (80%, n = 161) or en bloc resection (87.2%, n = 182). A repeated TURBT was performed when no muscle was found in the specimen (70.6%, n = 149) and/or if the tumor was stage pT1 (72.0%, n = 152) or high grade (63.0%, n = 133).
Conclusion: Implementation of resection techniques or repeated TURBT within EAU guidelines is promising, but it can be further challenged. For example, WLC/TURBT reporting should be improved since urologists consistently consider previous documentation. Given the moderate application rate of aTVMs, an attempt to increase its utilization would lead to a better assessment of its potential benefit.