Trans urethral endoscopic resection (with possible Hexvix®)

The procedure should be performed in all patients who following abdominal CT and/or flexible urethrocystoscopy are diagnosed with a neoformation within the bladder. It has a fundamental diagnostic value, as it allows to obtain the histological examination of the above mentioned lesion, fundamental in discriminating if a lesion is superficial or if it infiltrates the bladder musculature. In the case of a non-infiltrating lesion, it will also have a therapeutic purpose as it allows for complete removal of superficial lesions.

The procedure is performed under spinal anesthesia in the operating room. No surgical cuts required. A rigid cystoscope is introduced inside the urethra, equipped with an optical fiber that transmits the endoscopic image on a high-definition monitor and an electrical resector through which the tissue suspected for neoplasia is taken. If multiple suspicious areas are present in the bladder, all of these should be resected endoscopically.

Some patients may have a suspicion of bladder neoplasia, but the absence of recognizable bladder lesions. In these cases, preoperative intravesical instillation of a fluorescence-inducing drug, Hexvix, which accumulates in the neoplastic tissue, is necessary. Subsequently, a blue light optical fiber is inserted into the cystoscope, which fluoresces the areas in which the drug has accumulated, thus making it possible to highlight areas of the bladder suspected of neoplasia, not also visible to the naked eye.