Urinary bladder cancer is a global disease, and its burden will always be a challenge in the field of Urology. The first part of the lecture was given by Dr. Agus Hamid, a faculty of Medicine Universitas Indonesia. He discussed the epidemiology and the flow in diagnosing bladder cancer. In 2018, Asia and Europe  has the highest incidence of bladder cancer, both sexes and all ages. The economic burden of the disease made bladder cancer as one of the highest compared to other cancers.

Dr. Hamid emphasized the importance of history taking and physical examination, given the numbers of delayed and misdiagnosis. Tobacco smoking, occupational exposure to chemicals (aromatic amines) and incidence of schistosomiasis and cystolithiasis in the area must always be reviewed. The presence of UTI-like symptoms can also be misleading. Dr. Hamid also highlighted the limitations of urinary cytology and its Paris System for reporting. A positive result might be also due to other urothelial cancers, and its absence cannot rule out bladder cancer.

With advancing technology, Dr. Haman interestingly added mpMRI Vesical Imaging-Reporting and Data System (VI-RADS) for the diagnosis of bladder cancer. However, cystoscopy is still the gold standard adding that it can be both diagnostic and therapeutic at the same time. Dr. Haman also reiterated the advantages of blue-light cystoscopy and Narrow Band Imaging, especially in visualizing flat lesions and guiding the surgeon during TUR.

In toto, Dr. Haman pointed the significance of history taking and physical examination, and that different diagnostic tests adjunct each other to give the best specificity and sensitivity in the diagnosis of bladder cancer.

The second part of the lecture was given by a world-renowned expert in bladder cancer, Dr. Joan Palou, the chairman of European School of Urology. He discussed his deftness in whether to do transurethral resection (TUR), re-TUR, or en-bloc resection. Dr. Palou punctuated the importance of the first TUR to be wider and deeper to properly stratify the patient and decrease the need for re-TUR. He showed a video pointing out to always recheck and resect remaining suspicious lesions during TUR – “whenever you doubt that there is something left, resect more”. 

Dr. Palou also introduced the advantages of en-bloc TUR which can give high quality specimen for pathological evaluation. However, en-bloc TUR still needs further research whether this technique can avoid re-TUR and its influence towards recurrence and progression. Dr. Palou also added their on going study in using monopolar, bipolar or thulium energy for en-bloc TURBT.