En-bloc Transurethral Resection of Bladder Tumor (En-bloc TURBT) Specimens Using a Redesigned Surgical Resectoscope Device

Background:

• Bladder cancer is the sixth most common cancer in the United States, disproportionately affecting more men than women.
• The gold standard for the surgical treatment and diagnosis of non-muscle invasive bladder cancer is transurethral resection of bladder tumors (TURBT).
• TURBT requires the fragmentation of bladder tumors and piecemeal removal of these tumors.
• TURBT leads to loss of histopathologic information - including tumor orientation, size, and margin status - which may compromise outcomes and risk tumor seeding within the bladder.
• Given these multiple problems with TURBT we are testing some modifications to the current resectoscope device and the effect of these modifications on the quality of TURBT specimens produced.
• The redesigned resectoscope device will be tested ex-vivo on cystectomy specimens to avoid risks to patient safety.

Objectives:

The primary objective of this study is to determine if resectoscope device modification can provide improved pathologic standards for the TURBT procedure. An improvement in any of the parameters outlined below will constitute a device improvement in the current resectoscope:

• Presence of three tissue layers within the tumor specimens containing bladder mucosa, lamina propria, and portions of the muscularis.
• Information regarding tumor margin, assessed as the ability to ascertain if tumor is present at the margin of the resection.

Eligibility:

• Medical condition requiring surgical removal of the bladder
• Men and women, age >= 18 years

Design:

• Preclinical tissue acquisition trial, ex vivo, proof-of-concept.
• Following cystectomy, a modified resectoscope/redesigned resectoscope will be used to resect areas of tumor from the cystectomy specimens. These resected tumors will be sent with the cystectomy specimen for histopathology to assess the size of resection, depth of resection, and ability to ascertain tumor orientation.
• The remainder of the cystectomy specimens will undergo traditional histopathology. Histopathologic information from both specimens will be included in the final histopathologic diagnosis to ensure accurate oncology staging.
• This study will allow for about 2 years of accrual and the accrual ceiling will be set at 25 subjects.

• INCLUSION CRITERIA:
• Patients requiring surgical removal of the bladder at the NIH Clinical Center.

NOTE: Reasons for need for surgical removal of bladder include cancer or benign condition for which a surgeon determined surgical removal of the bladder is recommended. Patient's with invasive bladder cancer requiring cystectomy are eligible for enrollment. Bladder cancer remains the most common reason for cystectomy. Patients with clinical advanced disease and having other treatments/or participating in other trials remain eligible for enrollment in this study.

• Men and women
• Age greater than or less than 18 years
• Deemed clinically appropriate for the planned surgical procedure.
• Ability of subject to understand and the willingness to sign a written informed consent document.
• Subjects will be asked to co-enroll in 15-C-0087, "Care of the Urothelial Cancer Patient and Prospective Collection of Biospecimens from Healthy Volunteers and Urothelial Cancer Patients." NOTE: Most participants are expected to already be enrolled in 15-C-0087 prior to entry in this study.

Exclusion criteria

• Cystectomy during pregnancy would subject the fetus to significant risk of miscarriage or premature labor. For this reason, pregnant women are ineligible for this study.