En Bloc Resection of Bladder Tumour (EBRT)

En-Bloc Resection of Bladder Tumour (EBRT) – a better way to remove bladder tumours

Transurethral resection of bladder tumour (TURBT) has been the gold standard in managing non-muscle invasive bladder cancer (NMIBC). However, this technique violates the usual cancer control principle of removing tumours intact in a single piece. “Piecemeal resection” may cause scattering and spread of exfoliated tumours cells leading to increased recurrence rate. Other pitfalls of the traditional TURBT include difficulty in ensuring complete resection around the edges and depth of the tumour (to include the deeper muscle layers). Poor quality of resection can directly affect accuracy of staging and cancer control outcomes in early bladder cancer.

ERBT aims to remove the tumour in a “one-piece” fashion. Just like TURBT, this is performed endoscopically. EBRT is performed by making a circular cut around the margin beyond the edges of the tumour, followed by removal of the tumour with underlying bladder (detrusor) muscle. TUERBT specimens can maintain the 3D architecture of the tumour, thus allowing more accurate staging of bladder cancer with proper assessment of the resection margins (edges of tumour). A good assessment of the depth of invasion can reduce the need for a second look TURBT.

Dr Lincoln Tan helps train young urologists in the region on this technique through his work with AUSTEG- Asian Urological Surgery Training & Education Group

En-bloc resection of bladder tumour(EBRT) – the entire tumour is removed in a single piece including sufficient margin from the edges and depth of the tumour.Compare this to the piece removal of the tumour during TURBT below.