<p><strong> </strong><strong>At initial diagnosis of a patient with bladder cancer, clinicians should perform complete visual resection of the bladder tumor(s), when technically feasible. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>Incomplete TURBT is likely a significant contributing factor to early bladder cancer recurrences, as tumors are seen at first surveillance cystoscopy in up to 45% of patients.<sup>62</sup> Thus, complete TURBT is critical in management of NMIBC for accurate tumor type, staging, grading, and optimization of patient outcomes.<sup>62-64</sup> A lack of detrusor muscle in the resection specimens is associated with increased risk of understaging, residual disease on repeat TURBT, and early tumor recurrence.<sup>64, 65</sup> In addition to complete resection, bimanual examination under anesthesia after TURBT can also assist with clinical staging. Enhanced cystoscopy methods and resection techniques, such as bipolar electrocautery, may serve to enhance complete resection and reduce complications from TURBT.<sup>66-68</sup> For patients with a history of small, low-grade Ta tumors, however, office-based cystoscopy and fulguration of small recurrences or even cystoscopic surveillance are treatment options and may reduce overall therapeutic burden.<sup>69-72</sup> Emerging larger clinical experiences and confirmatory trials are needed to validate these conservative approaches.</p>