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Aktuelle Urol 2020; 51(04): 348-352
DOI: 10.1055/a-1171-1137
Übersicht

Verbesserungspotenziale durch neue Resektions- und Bildgebungstechniken bei der TUR-B

Potential for improvement by new resection and imaging techniques in TUR-B
Martin J. P. Hennig
Klinik für Urologie des Universitätsklinikums Schleswig-Holstein, Campus Lübeck
,
Mario W. Kramer
Klinik für Urologie des Universitätsklinikums Schleswig-Holstein, Campus Lübeck
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Zusammenfassung

Die transurethrale Resektion von Harnblasentumoren (TURB) ist ein Grundpfeiler in der urologischen Versorgung von Harnblasenkarzinompatienten. Seit der initialen Einführung von Resektoskopen vor knapp 100 Jahren hat sich an der grundlegenden Resektionstechnik wenig geändert. Erst mit der Verbreitung der sog. En-Bloc-Resektion (ERBT), welche im Gegensatz zur fragmentierten Abtragung die Tumorintegrität erhält, findet eine zögerliche Neujustierung der Technik statt. Vorteile, die der ERBT zugeschrieben werden, sind die bessere histopathologische Beurteilbarkeit und die höhere Detrusormuskulaturrate. Zudem sind Tendenzen für eine geringere Rate an sog. „in-field“ Rezidiven sowie eine verminderte Komplikationsrate beschrieben worden. Randomisierte, kontrollierte Studien mit geeigneter Fallzahl und Methodik stehen allerdings aus. Nur wenige Neuerungen hinsichtlich verbesserter endoskopischer Tumordiagnostik sind in den letzten Jahren hinzugekommen. Erwähnenswert ist die multiparametrische Magnetresonanztomografie der Blase, welche die Genauigkeit der lokalen Tumorausbreitung im Vergleich zur alleinigen konventionellen Bildgebung verbessern soll, sowie Verfahren aus dem Bereich der künstlichen Intelligenz. Die Intention dieses Artikels ist es einen aktuellen Stand über die ERBT sowie die lokale Diagnostik bei Harnblasentumoren zu geben.

Abstract

Transurethral resection of bladder tumors (TURB) is the cornerstone in urological care of bladder cancer patients. Since the introduction of resectoscopes almost 100 years ago, little has changed in the basic resection technique. The further dissemination of the en-bloc resection (ERBT), which in contrast to fragmented removal preserves the tumor‘s integrity, might re-adjust the surgical landscape. Benefits attributed to ERBT are better histopathological judgment and higher detrusor muscle rate. In addition, trends for a lower rate of so-called „in-field“ recurrences as well as a reduced complication rate have been described. However, randomised, controlled studies with appropriate case numbers and methodology are pending. Few innovations in improved endoscopic tumor diagnostics have been added in recent years. Worth mentioning is the multiparametric magnetic resonance imaging of the bladder, which is intended to improve the accuracy of local tumor propagation compared to conventional imaging alone, as well as techniques in the field of artificial intelligence. The intention of this article is to provide an up-to-date status on EBRT as well as the local diagnostics for urinary bladder tumors.

Schlüsselwörter

Urothelkarzinom - En-Bloc-Resektion - TURB

Keywords

bladder cancer - TURB - en-bloc resection


Publication History

Article published online:
10 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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