الفهرس 
Anatomy of Urinary BladderOnly 14 pages are availabe for public view
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Abstract
W
orldwide, bladder cancer (BCa) is the seventh most common malignancy in men and the seventeenth most common malignancy in women (Grasso and Eur Urol Suppl 2008).
Approximately 75-85% of all patients with BCa have disease confined to the mucosa (stage Ta or stage carcinoma in situ [CIS]) or submucosa (stage T1). This group of tumours is referred to as non-muscle-invasive or superficial BC as opposed to muscle-invasive disease staged as T2-T4 (Rigaud Urol et al., 2002).
Transurethral resection (TUR) of bladder tumours is the mainstay in the diagnosis and treatment of bladder cancer. The first and most important rule is the complete resection of the superficial tumours. This procedure is not only mandatory for adequate staging but also crucial in delaying or preventing tumour recurrence and progression (Brauers, et al., 2001).
Transurethral resection is used primarily in muscle-invasive bladder cancer to establish the diagnosis and local extent of the disease. The use of Transurethral resection tumor for definitive treatment of non muscle-invasive bladder cancer is predicated on tumor volume, multifocality, and associated carcinoma in situ (CIS). Understaging of the depth of tumor involvement occurs in up to 40% of cases. Nevertheless, several series have shown that TURT provides disease control, particularly in patients with lower clinical disease stages (Ricos et al., 1992).
The classification of superficial bladder tumor or better-known nonmuscle-invasive bladder tumors is based on two pillars: (1) the clinical stage following the TNM classification differentiating between Ta, which includes tumors not invading the submucosa, and T1, which invades the submucosa, but not the muscularis propria; and (2) the histological grade that refers to the 1973 WHO grading system based on the microscopic appearance of cancer cells. However, the major limitation of this classification is the vague definition and the lack of specific histological criteria without a reliable inter- and intraobserved correlation (Murphy et al., 2002).
Transurethral resection tumor is the key diagnostic modality to determine whether patients have bladder cancer that can be treated locally or requires more aggressive, surgical treatment. While TUR is an extremely common urologic procedure, it is not without complications (Hollenbeck, et al., 2006).
Unfortunately, the efficiency of the procedure is not optimal. Although TURT is a procedure familiar to all urologists, it is not easy to perform and may not always achieve the desired goals. Moreover, its potential failures have negative impacts on patient outcomes. It was shown that many of the so-called early recurrences are in fact persistent tumours that were overlooked and left behind during resection (Brausi et al., 2002).
The definition of complete and correct resection is to eradicate all macroscopic tumours, preferably in fractions, which includes the exophytic part of the tumour, the underlying bladder wall with the detrusor muscle, and the edges of the resection area. The specimens from different fractions must be sent to the pathologist in separate containers. Cauterisation has to be avoided as much as possible during the resection to prevent tissue destruction. The pathologic report should specify the grade of the lesion and the depth of tumour invasion into the bladder wall and provide information on whether the lamina propria and muscle are present in the specimen (Babjuk et al., 2008).
Second TURT refers only to those procedures performed 2-6 weeks following the complete TURT of the bladder (TURBT) defined above.
No body can guarantee that a complete TURT has been performed for the non-visualising microscopic tumours on the base or margins of the tumours. Nevertheless, the surgeon has to report that all visible tumours have been resected, and the pathologist has to reveal that lamina propria and muscularis propria were obtained. Moreover, the term second TURT should not be used for the repeat resection after incomplete resection having left behind residual tumour tissue because of factors such as multiplicity, size, and location. Restaging TUR is another term referring to TUR that provides additional pathologic information for the lamina propria or muscularis propria. Both the rate of the residual tumour and understaging after second TUR were reported, with a range of 28% to 74% and 1.7% to 64%, respectively, because of the complexities of definitions (Divrik, et al., 2006).
This study to show the positive impact of routine second TUR and its Values In Patients With Superficial Urinary Bladder Tumors on the long-term outcome (Zurkirchen et al., 2004).