Current European Trends in Endoscopic Imaging and Transurethral Resection of Bladder Tumors

The aim of this survey was to obtain an overview of current European standards in the endoscopic visualization and management of bladder tumors. An online survey was launched in July 2018 for a duration of 4 months. It was distributed to all members of the European Association of Urology (EAU) and included 23 questions divided into 3 thematic sections: general information, white light cystoscopy (WLC) and imaging, and transurethral resection of bladder tumor (TURBT) techniques. Responses of 222 participants were included for analysis. The majority of physicians were between 30 and 40 years of age (48.2%, n = 107) and performed over 50 TURBT per year (52.2%, n = 115). Overall, 52.3% (n = 116) reported WLC findings in written form only, 23.8% (n = 53) added endoscopic footage, and 79.2% (n = 176) considered preliminary WLC/TURBT reports before performing a subsequent bladder intervention. About half of the participants (50.5%, n = 104) used additional tumor visualization methods (aTVMs), but aTVMs were utilized by a greater proportion of physicians from Western countries (58.1%, n = 90) compared with developing countries (20.0%, n = 7). Photodynamic diagnosis was the predominant aTVM technique employed (43.8%, n = 60). Bipolar current was the most common technique for TURBT (46.6%, n = 149). Most urologists in this study occasionally utilized techniques like resections in fractions (80%, n = 161) or en bloc resection (87.2%, n = 182). A repeated TURBT was performed when no muscle was found in the specimen (70.6%, n = 149) and/or if the tumor was stage pT1 (72.0%, n = 152) or high grade (63.0%, n = 133). Implementation of resection techniques or repeated TURBT within EAU guidelines is promising, but it can be further challenged. For example, WLC/TURBT reporting should be improved since urologists consistently consider previous documentation. Given the moderate application rate of aTVMs, an attempt to increase its utilization would lead to a better assessment of its potential benefit.