BackTable Urology Ep. 204 Managing Low and Intermediate Risk Bladder Cancer with Dr. Betsy Koehne and Dr. Amir Salmasi
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Dec 6, 2024 Dr. Betsy Koehne specializes in bladder cancer at the University of Wisconsin, while Dr. Amir Salmasi is known for his impactful work at UC San Diego. They discuss contemporary strategies for managing low and intermediate-risk bladder cancer, emphasizing personalized care and effective patient communication. The conversation highlights the importance of understanding patient distress, advancements in intravesical therapies, and ongoing clinical trials aimed at improving outcomes. They also delve into the intricacies of postoperative surveillance and the role of pathology in treatment decisions.
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Initial Consultation Advice
- Always review imaging with the patient, explaining that next steps depend on pathology findings.
- Recommend blue light cystoscopy for higher detection rates, and prepare patients for potential follow-up visits.
TURBT Procedure Tips
- Start TURBT with a bimanual exam, even for low-grade tumors, to develop good habits.
- For smaller tumors, use cold cup resection, and for larger ones, use bipolar resection with a loop.
Loop Resection Technique
- When using a loop, cut in lower volume to avoid deep cuts and obturator reflex.
- Hook the loop behind the tumor, visualize the bladder wall and ureteral orifices, and take deeper bites separately.