Histopathological evaluation is still useful after bladder neck resection

Abstract

The idea behind this paper [1] is novel and daring. Firstly, there are no previous papers looking into the actual necessity of pathological examination after removing a part of the urinary tract. And secondly, there are many possible implications after changing something that is widely considered as elementary and routine. The conclusion that might be drawn from this paper is that if you are only looking for cancer, this might not be the best approach. But, since this type of surgery is done to relieve bladder outlet obstruction, you will most likely get a good clinical result regardless of the nature of the resected tissue. This would make a good argument for modern procedures like laser or plasma vaporization, when a biopsy would increase the total cost not only because of the pathological examination but also because of the extra time and the extra loop which is needed. But even in this field there are many voices saying that a preoperative biopsy might save a lot of trouble in the long run and, by that, be more than recommended. This will probably remain a hot topic for a while, with many good arguments from both sides [2]. The macroscopic aspect of the tissue in the area of interest might also provide a clue as to whether there is something suspect or just plain fibrosis. But the subjective opinion of the urologist might not be enough in the case of his decision being challenged at a later time and no hard evidence is available [3]. The most important argument of the authors for not doing a biopsy is the cost of the pathological examination. In their study, they had only two patients confirmed with prostate cancer out of a total of 340 patients. More than this, those two patients were known to have prostate cancer before the resection. For the rest of the group, the pathological examination diagnosed BPH or inflammation of the prostate or the bladder. The authors consider that the cost of diagnosing two cases of cancer is equivaHistopathological evaluation is still useful after bladder neck resection