2. UroToday Home
  3. Recent Abstracts
  4. Urologic Oncology
  5. Bladder Cancer

Pathological Assessment of Morcellated Tissue after ERBT: Insights from a Two-Round Delphi Survey - Beyond the Abstract

En bloc resection of bladder tumor (ERBT) is becoming increasingly popular because of several potential advantages over conventional trans urethral resection of bladder tumor (TURBT). Multiple studies have demonstrated better specimen quality, higher detrusor muscle detection rates, improved surgical margins, fewer bladder perforations, and lower catheterization time.1–5 Modern laser systems further facilitated the development of ERBT by allowing more controlled dissection with minimal bleeding and limited thermal damage to the specimen.6–8

Current meta-analyses generally show at least comparable oncological outcomes,9,10 while some recent prospective studies and updated analyses suggest that ERBT may potentially improve oncological outcomes in selected patients.4,11

At the same time, the management of large bladder tumors still remains challenging. Small tumors can usually be removed intact through the endoscope sheath, while lesions larger than 3 cm often require additional extraction techniques. Morcellation may be one possible solution, allowing fast, safe, and minimally invasive retrieval of large tissue specimens.12,13 However, concerns still exist regarding the quality of pathological assessment after morcellation.

In their study, Ventura et al. conducted an international two-round Delphi survey involving experienced uropathologists from leading academic centers. The panel evaluated digital slides obtained after ERBT, followed by morcellation, and assessed the main pathological parameters important for bladder cancer staging and grading.

The survey showed agreement that morcellation does not compromise overall specimen quality, tumor grading, histological typing, assessment of lymphovascular and perineural invasion, and detection of detrusor muscle. In the second Delphi round, all experts agreed that morcellated specimens allow for proper staging, assessment of detrusor muscle invasion, and identification of carcinoma in situ (CIS).

Overall, the current study suggests that tissue obtained after ERBT with subsequent morcellation remains suitable for pathological evaluation and may help expand the use of ERBT for large bladder tumors.

Written by: Yossi Ventura,1 Andrey Morozov,2 Ronald Chan,3 Marcelo Combat Faria Tavares,4 Jeremy Yuen-Chun Teoh,5 Eva Compérat,6,7 Liang Cheng,8 Eddie Fridman,9,10 Julia Lerner,11 Ezra Baraban,12 Max Yakimov,13 Konstantin Lokshin,14 David Lifshitz,1,10 Shay Golan,1,10 Vineet Gauhar,15,16 Thomas R. W. Herrmann,17,18,19 Shahrokh Shariat,2,20,21,22,23 Dmitry Enikeev,1,2,10,20

  1. Department of Urology, Rabin Medical Center, Hasharon Hospital, Petah Tikva, Israel.
  2. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
  3. Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
  4. Pathologic Anatomy Laboratory, Federal University of Minas Gerais (UFMG), Brazilian Company of Hospital Services, Clinical Hospital, Belo Horizonte, MG, Brazil.
  5. Department of Surgery, S. H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
  6. Department of Pathology, Tenon Hospital, Sorbonne University, Paris, France.
  7. Department of Pathology, Medical University of Vienna, Vienna, Austria.
  8. Department of Pathology and Laboratory Medicine, Department of Surgery (Urology), Brown University Warren Alpert Medical School, the Legorreta Cancer Center at Brown University, Brown University Health, Providence, RI, USA.
  9. Department of Diagnostic Pathology, Sheba Medical Center, Ramat Gan, Israel.
  10. Gray Faculty of Medical and Health Sciences, Tel Aviv University, Chaim Levanon St 55, Tel Aviv-Yafo, 6997801, Israel.
  11. Institute for Clinical Morphology and Digital Pathology, Sechenov University, Moscow, Russia.
  12. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  13. Pathology Department, Rabin Medical Center, Petah Tikva, Israel.
  14. Kent and Canterbury Hospital, East Kent Hospitals University Foundation, Canterbury, UK.
  15. Ng Teng Fong General Hospital (NUHS), Singapore, Singapore.
  16. Asian Institute of Nephrourology (AINU), Chennai, India.
  17. Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland.
  18. Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Stellenbosch, South Africa.
  19. Hannover Medical School, Hannover, Germany.
  20. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
  21. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
  22. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  23. Department of Urology, Weill Cornell Medical College, New York, NY, USA.
References:

  1. Gao W. Current laser application in En bloc resection of bladder tumor- a narrative literature review. World Journal of Surgical Oncology [Internet]. 2025 Dec 1 [cited 2025 Jul 15];23(1):1–10.
  2. Teoh JYC, D’Andrea D, Gallioli A, Yanagisawa T, MacLennan S, Nicoletti R, et al. En bloc resection of bladder tumour: the rebirth of past through reminiscence. World J Urol [Internet]. 2023 Oct 1 [cited 2025 Jul 15];41(10):2599–606.
  3. D’Andrea D, Soria F, Hurle R, Enikeev D, Kotov S, Régnier S, et al. En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial. Eur Urol Oncol [Internet]. 2023 Oct 1 [cited 2025 Jul 15];6(5):508–15.
  4. Teoh JY, Cheng CH, Tsang CF, Kai-Man Li J, Kwun-Chung Cheng B, Hoi-Chak Chan W, et al. Transurethral En Bloc Resection Versus Standard Resection of Bladder Tumour: A Randomised, Multicentre, Phase 3 Trial. Eur Urol. 2024;86:103-11.
  5. Tonin E, Shariat SF, Schiavina R, Brunocilla E, D’Andrea D. En-bloc resection of non-muscle invasive bladder cancer: Does it really make a difference? Curr Opin Urol [Internet]. 2023 Mar 1 [cited 2025 Jul 15];33(2):147–51.
  6. Enikeev, D., Morozov, A., Shpikina, A., Fajkovic, H., Baniel, J., & Herrmann, T. R. W. (2023). A 10-year renaissance of en bloc resection of bladder tumors (ERBT): Are we approaching the peak or is it back to the trough?. World journal of urology, 41(10), 2607–2615.
  7. Herrmann TRW. En bloc resection of bladder tumors (ERBT) revisited 12 years after reintroduction: too good to be further ignored. World J Urol. 2023;41(10):2577-2582.
  8. Enikeev D, Taratkin M, Margulis V, et al. Safety and Short-Term Oncological Outcomes of Thulium Fiber Laser En Bloc Resection of Non-Muscle-Invasive Bladder Cancer: A Prospective Non-Randomized Phase II Trial. Bladder Cancer. 2020;6(2):201-210.
  9. Yanagisawa, T., Mori, K., Motlagh, R. S., Kawada, T., Mostafaei, H., Quhal, F., Laukhtina, E., Rajwa, P., Aydh, A., König, F., Pallauf, M., Pradere, B., D'Andrea, D., Compérat, E., Miki, J., Kimura, T., Egawa, S., & Shariat, S. F. (2022). En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology. The Journal of Urology, 207(4), 754–768.
  10. Basile, G., Uleri, A., Leni, R., Cannoletta, D., Afferi, L., Baboudjian, M., Diana, P., D'Andrea, D., Teoh, J., Pradere, B., Subiela, J. D., Laukhtina, E., Seisen, T., Rouprêt, M., Briganti, A., Montorsi, F., Moschini, M., Breda, A., Gallioli, A., & European Association of Urology—Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group (2025). En Bloc Versus Conventional Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-analysis of Oncological, Histopathological, and Surgical Outcomes. European urology oncology, 8(2), 520–533.
  11. Petov, V., Timofeeva, E., Sukhanov, R., Baniel, J., Mustafin, M., Fajkovic, H., Morozov, A., Teoh, J. Y., Singla, N., Laukhtina, E., Herrmann, T. R., Shariat, S. F., & Enikeev, D. (2024). Prospective non-randomized comparison of transurethral laser en bloc resection vs. conventional resection of bladder tumors larger than 3 cm. Minerva urology and nephrology, 76(4), 436–441.
  12. Iscaife, A., Ribeiro Filho, L. A., Aparecido Pereira, M. W., Gallucci, F. P., Chade, D., Murta, C. B., Cordeiro, M. D., Cardili, L., Sarkis, A. S., Srougi, M., & Nahas, W. C. (2022). Holmium Laser Resection of Large Bladder Tumors: Technique Description, Feasibility, and Histopathological Quality Analysis. Urology, 165, 373.
  13. Dekel, N., Laukhtina, E., Morozov, A., Compérat, E., Fridman, E., Golan, S., Teoh, J. Y., Molchanov, Y., Yakimov, M., Herrmann, T. R. W., Pushkar, D., Moreno Sierra, J., Gómez Rivas, J., Shariat, S. F., & Enikeev, D. (2025). The Role of Morcellation in En Bloc Resection of Large Bladder Tumors. Diagnostics (Basel, Switzerland), 15(6), 716.
Read the Abstract