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Transurethrale Resektion der Harnblase

Was ist Standard, was kommt?

Transurethral resection of the urinary bladder

Status quo and outlook on new developments

Zusammenfassung

Hintergrund

Die transurethrale Resektion der Harnblase (TURB) ist der etablierte Standardeingriff zur Behandlung und diagnostischen Evaluation des nicht-muskelinvasiven Harnblasenkarzinoms (NMIBC). Zur Verbesserung der relevanten Rate an Rezidiven und des Komplikationsrisikos ist die stetige technische Weiterentwicklung des Verfahrens von hohem medizinischem Interesse.

Fragestellung

Aktuelle Standards werden dargestellt und technologische Veränderungen diskutiert.

Material und Methoden

Derzeitige Leitlinienempfehlungen sowie die Datenlage in der Literatur werden analysiert.

Ergebnisse

Das Anwendungsspektrum der klassischen TURB wird durch neue Resektionsmethoden (en bloc) und -technologien (bipolares und lasergestütztes Schneiden) ergänzt. In Kombination mit einer verbesserten Visualisierung durch teilweise bereits etablierte Technologien der photodynamischen und digitalen Bildverstärkung zeigt sich ein Optimierungspotenzial hinsichtlich der Rezidiv- und Komplikationswahrscheinlichkeit sowie der histologischen Qualität des Resektats.

Schlussfolgerung

Eine positive Beeinflussung der onkologischen Wertigkeit und Sicherheit der TURB scheint durch die Anwendung moderner Weiterentwicklungen möglich. Eine weiterführende Etablierung bis hin zu evidenzbasierten Leitlinienempfehlungen ist nötig.

Abstract

Background

Transurethral resection of the urinary bladder (TURB) is the standard intervention in the diagnostic workup and treatment of non-muscle invasive bladder cancer. In order to minimize cancer recurrence and potential complications, continuous technical development of TURB is of high clinical interest.

Objectives

Presentation of the current standards and discussion of technological changes.

Materials and methods

Analysis of the current guideline recommendations and literature research.

Results

The limitations of classic monopolar TURB is supplemented by new resection methods (en bloc) and technologies (bipolar and laser resection). Along with improved visualization through partially established technologies of photodynamic and digital image enhancement, there is potential for optimization regarding the likelihood of recurrences and complications as well as the histological quality of the resected material.

Conclusion

A positive impact on the oncological value and safety of TURB seems possible through the use of modern technologies. Further establishment up to evidence-based guideline recommendations are necessary.

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Authors

Corresponding author

Correspondence to Michael Straub.

Ethics declarations

Interessenkonflikt

M. Straub ist Consultant der Firma Richard Wolf GmbH. M. Jahnen, F. P. Kirchhoff und J. E. Gschwend geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

M. Jahnen und F. P. Kirchhoff sind gleichberechtigte Erstautoren.

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Jahnen, M., Kirchhoff, F.P., Gschwend, J.E. et al. Transurethrale Resektion der Harnblase. Urologe 60, 1416–1423 (2021). https://doi.org/10.1007/s00120-021-01679-2

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Schlüsselwörter

  • Resektion
  • Enhancement
  • Harnblasenkarzinom
  • Photodynamische Diagnostik
  • Elektrokoagulation

Keywords

  • Resection
  • Enhancement
  • Urinary bladder neoplasms
  • Photodynamic diagnosis
  • Electrocoagulation