The UroOnc Minute: En bloc resection vs TURBT, with Jeremy Y.C. Teoh, MBBS, FRCSEd, FCSHK, FHKAM

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, speaks with Jeremy Y.C. Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM (Surgery), associate professor of urology at The Chinese University of Hong Kong, about the evolving role of en bloc resection of bladder tumor (ERBT) in the management of non–muscle-invasive bladder cancer (NMIBC). Teoh provides a concise overview of the oncologic rationale behind ERBT, which emphasizes removal of the tumor in a single piece to preserve tissue architecture, reduce tumor cell dispersion, and enable more accurate pathologic margin assessment.

Teoh highlights results from a multicenter randomized trial conducted across 13 centers in Hong Kong, comparing ERBT with conventional transurethral resection of bladder tumor (TURBT) using standard instruments.¹ The study demonstrated a significant reduction in 1-year recurrence rates with ERBT (28.5% vs 38.1%; P = .007), with comparable safety profiles between techniques. Importantly, the findings confirmed that ERBT is technically feasible and generalizable beyond expert centers, provided appropriate training and dissemination of technique.

The discussion also explores how ERBT integrates with adjuvant therapy. Teoh reviews post hoc analyses showing that while ERBT improves upfront local control, combining ERBT with intravesical BCG therapy further enhances outcomes in high-risk NMIBC.² In this setting, ERBT plus BCG was associated with a markedly lower 1-year recurrence rate compared with standard resection plus BCG (5% vs 26%; P = .059), underscoring the complementary roles of high-quality surgery and immunotherapy in disease control.

Looking ahead, Teoh outlines several ongoing and planned initiatives, including randomized trials evaluating ERBT with intravesical chemotherapy maintenance, comparative studies of TURBT plus BCG vs ERBT plus BCG, and the development of a global ERBT registry to capture real-world outcomes. He also discusses early clinical experience with a novel transurethral robotic platform designed to facilitate ERBT, which has demonstrated promising safety and oncologic results and recently received FDA Breakthrough Device designation.³ Together, these efforts aim to refine surgical technique, optimize adjuvant strategies, and further reduce recurrence rates for patients with NMIBC.

REFERENCES
1. Teoh JYC, Cheng CH, Tsang CF, et al. Transurethral En Bloc Resection Versus Standard Resection of Bladder Tumour: A Randomised, Multicentre, Phase 3 Trial. Eur Urol. 2024 Aug;86(2):103-111. doi: 10.1016/j.eururo.2024.04.015

2. Teoh JYC, Wong CHM, Cheng CH, et al. Impact of Intravesical Bacillus Calmette-Guérin Therapy Following Transurethral En Bloc Resection of Bladder Tumour: Post Hoc Analysis of a Randomised, Multicentre, Phase 3 Trial. Eur Urol Oncol. 2025:S2588-9311(25)00245-7.doi:10.1016/j.euo.2025.09.008

3. Teoh JYC, Bracco FM, Wong JHF, et al. A Novel Transurethral Robotic Platform for Performing En Bloc Resection of Bladder Tumour: Results from the First Phase of the VIABLE Trial. Eur Urol Oncol. 2025:S2588-9311(25)00293-7. doi:10.1016/j.euo.2025.11.005