Editing Transurethral Resection of Bladder Tumour (section)

== Alternatives to TURBT ==

=== Cold-cup biopsy forceps ===

* '''Small tumors may be resected using the cold-cup biopsy forceps alone'''.
**This is especially helpful in elderly women, who are predisposed to perforation owing to their thin-walled bladders. 
***If perforation occurs, the cup causes a smaller hole than does the cutting loop.
***A Bugbee electrode facilitates hemostasis.

=== In-office fulguration ===

* Fulguration approach does not obtain tissue for pathologic evaluation
*'''Consider in-office fulguration as an alternative to resection under anesthesia in those patients in whom (4):'''
*#'''Diagnosis of TaLG disease or PUNLMP has been previously established and''' 
*#'''Lesion(s) is papillary in appearance, rather than sessile or flat, and''' 
*#'''Lesion(s) ≤ 1 cm''' 
*#'''Normal urine cytology'''
*#*Urine cytology suspicious for urothelial carcinoma is at higher risk for harboring occult high-grade disease and warrants pathologic evaluation of any visible lesion.

=== Observation ===

*Many small, low-grade tumors can be safely observed until they exhibit significant growth because of the minimal risk of progression

=== Laser fulguration ===

* '''Tumour resection can also be done with laser therapy.'''
** Because no tissue available for pathologic inspection, the optimal candidate for laser therapy is the patient with recurrent, low-grade lesions whose biology is already known
** '''Optimal laser for fulguration of bladder tumors is Neodymium-doped yttrium aluminium garnet (Nd:YAG)'''