top of page

BackTable / Urology / Podcast / Episode #46

Techniques & Maneuvers for Optimal TURBT

with Dr. Sam Chang

In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Dr. Sam Chang, chief of urologic oncology at Vanderbilt University, about surgical tips and tricks for intermediate and high risk bladder cancer.

Be part of the conversation. Put your sponsored messaging on this episode. Learn how.

Techniques & Maneuvers for Optimal TURBT with Dr. Sam Chang on the BackTable Urology Podcast)
Ep 46 Techniques & Maneuvers for Optimal TURBT with Dr. Sam Chang
00:00 / 01:04

BackTable, LLC (Producer). (2022, July 20). Ep. 46 – Techniques & Maneuvers for Optimal TURBT [Audio podcast]. Retrieved from https://www.backtable.com

Free CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs. Follow the button below to claim your credits on CMEfy.

BackTable CMEfy button

Stay Up To Date

Follow:

Subscribe:

Sign Up:

Podcast Contributors

Dr. Sam Chang discusses Techniques & Maneuvers for Optimal TURBT on the BackTable 46 Podcast

Dr. Sam Chang

Dr. Sam Chang is the chief of urologic oncology at Vanderbilt University in Nashville, Tennessee.

Dr. Aditya Bagrodia discusses Techniques & Maneuvers for Optimal TURBT on the BackTable 46 Podcast

Dr. Aditya Bagrodia

Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.

Synopsis

First, the doctors discuss important considerations during the initial patient visit. Dr. Chang emphasizes that reviewing previous evaluations and treatments is important for patients with recurrent disease. Also, if the patient is a current smoker, smoking cessation should be encouraged. Dr. Chang will not perform a cystoscopy if the lesion is obvious. However, he acknowledges that this procedure may be necessary if the imaging is ambiguous. Some tips and tricks he shares for blue light cystoscopy include: using lidocaine, applying pressure when passing the scope, and training effective procedure nurses. He notes that residents will greatly improve their cystoscopy skills as they gain more experience.

Next, Dr. Chang shares his tips for a transurethral resection of bladder tumor (TURBT). He usually employs a bipolar TURBT and starts resecting in a normal-appearing bladder, being sure to balance speed with judiciousness when resecting. Additionally, he tries to obtain pathologic specimens from various tissue sites and the appropriate tissue layer orientation in order to facilitate pathological analysis of the tumor. Further, he notes that thorough OR dictation matters greatly, especially if the patient transfers to the care of a different provider or if a revision surgery is needed. He encourages urologists to give as many details as possible about the appearance, location, size, and nature of the tumor. For bladder carcinoma in situ, Dr. Chang cauterizes the tumor instead of resecting it in order to spare the specimen from destruction. For tumors involving the diverticulum, he obtains his sample with extra caution, as this location increases the possibility of tumor spillage. Then, the doctors compare and contrast different types of intravesical therapy.

Finally, the doctors discuss postoperative TURBT care. Dr. Chang usually does not place a postoperative stent because most of his patients do not develop stenosis. However, in cases of CT-proven hydronephrosis, a stent is necessary. He will also leave a catheter in all his patients for 3-4 days to prevent clot retention during recovery. Finally, he prescribes post-operative maintenance gemcitabine. Revision resection procedures if there was lots of tumor left behind after the first surgery or if the tumor was present in a difficult anatomic location. Dr. Chang repeats the resection before administering intravesical therapy. Lastly, he emphasizes that in cases of muscle-invasive bladder tumors, he would rather get rid of all the tumor than worry about preserving muscle.

Transcript Preview

[Sam Chang MD]
I hate partial cystectomy and diverticulectomy for bladder cancer and tumor and a TIC. When was the last time I did it, I haven't done it in 20 years. Do I believe it's effective therapy? No. What does it say in the textbooks? That's what you should do. I don't believe in it. So my algorithm is you sample as carefully as you can the tumor. If it looks papillary, you know, if it looks worried, I advocate cystectomy, because it's tumor there, that's worrisome is just like tumor somewhere else that's worrisome, that you cannot completely resect. So think of a T1 tumor that you can't completely resect or high-grade TA you can't for whatever reason, you cannot completely resect. I recommend cystectomy so wildly that's our number one or path split cystectomy. The other is I tend to treat these with intravesical therapy and aggressive TUR in full duration and the majority of patients end up doing fine. I really counsel them saying, look, if you want to try to save your bladder, we're taking a real risk here. And I have had a handful of patients that have tried intravesical therapy that have exploded. And would that have happened if I'd taken out their bladder or done a diverticulectomy? I think disease trumps everything, I think probably so but, I don't know for sure.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

backtable-earn-free-cme.jpg
backtable-plus-vi-cta.jpg
Become a BackTable Sponsor

Up Next

Maximizing Knowledge & Surgical Preperation: Strategies for Trainees with Dr. George Moran on the BackTable Urology Podcast)
ASCO 2024: Game-Changing GU Oncology Updates in Bladder & Kidney Cancers with Dr. Sumanta Pal and Dr. Petros Grivas on the BackTable Urology Podcast)
Latest Approaches to Treat High-Risk NMIBC with Dr. Ashish Kamat on the BackTable Urology Podcast)
Family Planning for Female Urologists: Facts & Figures with Dr. Christine Van Horn and Dr. Charla Holdren on the BackTable Urology Podcast)
Essential Skills for New Residents with Dr. Nathanaelle Ibeziako on the BackTable Urology Podcast)
Perfecting Rectal Spacer Placement for Optimal Care with Dr. Neil Taunk on the BackTable Urology Podcast)

Articles

Doctor holding cystoscope for TURBT procedure

TURBT Procedure for Bladder Cancer

Topics

Bladder Cancer Condition Overview
Cystoscopy Procedure Prep
Transurethral Resection Procedure Prep

Get in touch!

We want to hear from you. Let us know if you’re interested in partnering with BackTable as a Podcast guest, a sponsor, or as a member of the BackTable Team.

Select which show(s) you would like to subscribe to:

Thanks! Message sent.

bottom of page