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PEER-TO-PEER CLINICAL CONVERSATIONS
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Improving TURBT Quality in NMIBC
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Surgical Management of NMIBC: Comparing En Bloc to Standard Resection Techniques
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Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM
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| Jeremy Teoh describes a randomized trial of en bloc versus conventional TURBT. The trial included 350 patients across 13 hospitals in Hong Kong with one-year recurrence rate as the primary outcome.
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The EMBRACE Trial: An Enhanced Recovery After Surgery Pathway for Transurethral Resection of Bladder Tumors
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Max Kates, MD, and Michelle Higgins, MD
Michelle Higgins presents the EMBRACE randomized controlled trial of enhanced recovery protocol for ambulatory TURBT with Max Kates. The Quality of Recovery 15 score showed a 12-point improvement in the ERAS group, exceeding the six-point threshold for clinical significance.
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AUA 2026 Bladder Cancer Presentations: EG70, POTOMAC, and En-bloc Resection
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Patrick Hensley, MD
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| Patrick Hensley discusses the AUA 2026 bladder cancer program, identifying sessions he considers most important. The Friday plenary included data on detalimogene (EG70), along with POTOMAC updates and a phase 2 trial of pembrolizumab combined with BCG in highest-risk high-grade T1 disease. The John Lattimer lecture featured Dr. Jeremy Teoh on robotic en-bloc TURBT, and the SUO/SBUR joint session covered ctDNA and urine tumor DNA for minimal residual disease assessment in urothelial cancer.
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TURBT Quality, Staging, and Recurrence Prevention
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| Optimizing Surgical Management of Non-Muscle Invasive Bladder Cancer
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| Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM
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| Jeremy Teoh emphasized that high-quality TURBT is the cornerstone of NMIBC management and that en bloc resection (ERBT) can improve this by removing the tumor intact, reducing reimplantation risk, and allowing better margin and depth assessment. The randomized EB-StaR trial showed lower 1-year recurrence with ERBT, especially in intermediate-risk and selected low-volume tumors, and suggested that better resection may enhance adjuvant intravesical therapy.
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| Intraoperative Skills for Transurethral Resection of Bladder Tumor: Objective Assessment and Construct Validity of the ENTRY Metrics - Beyond the Abstract
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| Pietro Diana, MD, Andrea Gallioli, MD, and Alberto Breda, MD, PhD
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| This study evaluated objective intraoperative metrics for TURBT performance by having three blinded urologists score 30 videos of standardized, small bladder tumor cases. Experts had significantly fewer overall, noncritical, and critical errors than novices, with C-indices of 0.66–0.73 confirming that the metrics reliably discriminate between expertise levels.
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| Holmium Laser En-Bloc Resection Versus Conventional TURBT for Large NMIBC: Safety and Mid-term Oncological Outcomes from a Prospective Randomized Trial
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| Maykon Pereira, MD
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| Maykon Pereira discusses a prospective randomized trial of 97 patients with large NMIBC which showed that holmium laser en bloc resection is safe and feasible, with significantly fewer bladder perforations and shorter catheterization time compared to conventional TURBT, while providing similar overall operative parameters and hospital stay. Although detrusor muscle sampling rates were not statistically different, pathological staging was improved with more T1 classifications after en bloc resection, and residual tumor rates at re-TURBT were comparable.
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| Transurethral Robotic en-bloc TURBT-Challenging Status Quo
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| Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM
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| In his John K. Lattimer Lecture at AUA 2026, Dr. Jeremy Teoh challenged the conventional TURBT paradigm by highlighting its limitations (piecemeal resection, poor staging, tumor scattering) and advocating en-bloc resection, which improves specimen integrity and oncologic control but remains technically demanding.
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Impact on Oncological Outcomes of Detrusor Muscle Absence in pTaHG Urothelial Carcinoma of the Bladder? the End of the "Jump" of the Lamina Propria Layer Myth - Beyond the Abstract
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| Gabrielle Tissot
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| This multicenter real-life study of 418 patients questioned the routine use of re-TURB in pTa high-grade (pTaHG) bladder tumors when detrusor muscle is absent from the initial specimen, challenging the longstanding “lamina propria jump” myth that tumor can skip to muscle without intervening invasion. Over five years, absence of detrusor muscle in the first resection did not increase recurrence or progression risk, and performing a second resection in these patients did not improve progression-free survival.
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| Recurrence Patterns in a Large Contemporary Cohort of Patients With Non-Muscle Invasive Bladder Cancer - Beyond the Abstract
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| Jasper Hof PhD, and Sita Vermeulen, MD, PhD
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| This large cohort study of 1,915 NMIBC patients shows that subsequent recurrences are common and their timing and risk are best predicted by the tumor characteristics of prior recurrences, not simply by whether it is the first or later event. Individual patients do not show accelerating recurrence intervals over time, and the apparent population-level increase in recurrence rates for later recurrences likely reflects limited follow-up rather than true biological acceleration.
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