Dr. Jose Silva talks with Urologist Dr. Aditya Bagrodia from UT Southwestern Medical Center about the medical and surgical management of bladder cancer.

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SHOW NOTES

In this episode of BackTable Urology, UT Southwestern urologic oncologist Dr. Aditya Bagrodia joins our host Dr. Jose Silva to discuss the diagnosis, surgical treatment, and post-operative management of bladder cancer.

The episode opens with a brief overview of the initial workup for a suspected bladder tumor with imaging and cystoscopy, then quickly moves into the OR for definitive treatment and establishment of a tissue diagnosis. Dr. Bagrodia walks us through his surgical approach for transurethral resection of a standard bladder tumor and explains some of his techniques for optimal visualization, resection in challenging locations, and minimizing cautery artifact in smaller tumors to provide the pathologist with enough tissue for a pathological diagnosis.

The conversation then turns to more complex or unusual cases, starting with the approach to particularly large tumors that are likely to be muscle-invasive. Dr. Bagrodia emphasizes the importance of working closely with medical oncology in these cases requiring multimodal therapy, then discusses how he balances the risks and benefits of aggressive resection versus a “less is more” philosophy based on the overall clinical picture. When aggressive resection is appropriate, blue light cystoscopy is particularly helpful in resecting not just the visible tumor but also peritumoral dysplasia and carcinoma in situ. The pair also discuss when to place a stent or even a nephrostomy tube when resecting at the ureteral orifice, how to troubleshoot significant urethral stricture disease, and approach to hemostatic control in difficult cases.

The episode ends with a discussion of bladder-sparing techniques for muscle-invasive bladder cancer, a guideline-directed option still largely regionalized in the United States. Dr. Bagrodia first reviews some of the relative contraindications to a bladder preserving approach, then emphasizes that it can be an efficacious option in appropriate, motivated patients so should be a treatment option included in the conversation with these select patients.

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RESOURCES

AUA Guidelines, Non-Muscle Invasive Bladder Cancer: https://www.auanet.org/guidelines/guidelines/bladder-cancer-non-muscle-invasive-guideline
AUA Guidelines, Muscle-Invasive Bladder Cancer: https://www.auanet.org/guidelines/guidelines/bladder-cancer-non-metastatic-muscle-invasive-guideline