Is the Use of Cold-Cup Biopsy Necessary at the End of Transurethral Resection of Bladder Tumors?

Bladder cancer is a significant cause of morbidity and mortality today. Histopathological staging [1,2] and adequate tumor clearance is critical in prognosticating and assessing adequacy of treatment. Obtaining detrusor muscles during transurethral resection of bladder tumours (TURBT) is vital for cancer staging [3]. Deep cold-cup biopsy at transurethral resection of bladder tumors (TURBT) is not a routine evidence-based practise, and its ability to obtain more accurate pathological staging is not conclusive. Superficial bladder cancer is now routinely treated with bladder preserving endourological surgery. Transurethral resection of bladder tumor (TURBT) is now the accepted modality of treating most forms of superficial bladder tumors. TURBT specimens are sent to the histopathologist piecemeal and staging and adequacy of tumor clearance is based upon this. Bladder cancers are often understaged or found to have persistant tumor during a first endoscopic resection of bladder tumors and hence a relook TURBT is recommended in higher risk bladder tumors [4]. Various techniques have been decribed to obtain adequate depth of resection during a TURBT [5]. The use of smoothelin has been described to distinguish between muscularis mucosae and muscularis propria [6]. Reports of fractional resection of the tumor base for separate histopathological assessment have also been described [4]. This study aims to investigate the necessity of a cold cup biopsy after a TURBT. In addition, we also aim to assess the usefulness of cold cup bladder biopsies to further aid in the adequacy of TURBT, prognostication and staging of bladder cancers. Finally, we also aim to assess the safety of a bladder biopsy and assess for any complications that may arise due to the biopsy.