Background/Objectives: Conventional transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC) is usually performed in a piecemeal manner, leading to difficulties in accurate pathological assessment. En bloc resection of bladder tumor (ERBT) has been developed to address these limitations, offering improved specimen quality. So far, ERBT has been restricted to small bladder tumors due to difficulties in en bloc extraction of large ones (>3 cm). Recently, the morcellation technique has been proposed to facilitate the removal of large bladder tumors during ERBT. This narrative review aims to evaluate the feasibility of ERBT with subsequent morcellation for large bladder tumors, focusing on its role in tumor extraction and its impact on pathological assessment. Methods: A comprehensive literature search was conducted across multiple databases to identify studies evaluating the use of morcellation in ERBT for large bladder tumors. Inclusion criteria comprised studies reporting recurrence rates, detrusor muscle (DM) presence in pathological specimens, and perioperative complications. Additionally, we offered uropathologists a questionnaire to gather their perspectives on the use of morcellation following ERBT, focusing on its impact on pathological assessment, margin evaluation, and staging accuracy. Results: While there is limited evidence on the use of morcellation in ERBT for tumors larger than 3 cm and its impact on oncologic outcomes, morcellation has shown potential in facilitating the retrieval of large tumor specimens, ensuring clear resection margins and accurate staging. However, the learning curve for morcellation techniques and the need for specialized equipment may limit widespread adoption. Conclusions: Morcellation in ERBT for large bladder tumors represents a promising advancement in the management of these challenging cases, offering adequate pathological assessment and oncologic outcomes. Pathologists' reviews of morcellated specimens will likely further validate the technique. Continued research and technological innovations are necessary to optimize its implementation in clinical practice.
Diagnostics (Basel, Switzerland). 2025 Mar 13*** epublish ***
Nadav Dekel, Ekaterina Laukhtina, Andrey Morozov, Eva Compérat, Eddie Fridman, Shay Golan, Jeremy Yuen-Chun Teoh, Yossef Molchanov, Maxim Yakimov, Thomas R W Herrmann, Dmitry Pushkar, Jesús Moreno Sierra, Juan Gómez Rivas, Shahrokh F Shariat, Dmitry Enikeev
Department of Urology, Rabin Medical Center, Petah Tikva 4941492, Israel., Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia., Department of Pathology, Hôpital Tenon, Sorbonne Université, 75006 Paris, France., Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel., S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China., Department of Diagnostic Pathology, Sheba Medical Center, Ramat Gan 52621, Israel., Pathology Department, Rabin Medical Center, Petah Tikva 4941492, Israel., Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Western Cape, 8596 Frauenfeld, Switzerland., Department of Urology, Moscow State University of Medicine and Dentistry (MSMU), Moscow 127473, Russia., Department of Urology, Hospital Clínico San Carlos, 111821 Madrid, Spain.