Diagnosis and endourological treatment of non-muscle-invasive bladder tumors: Summary of Ph.D. Thesis in Medical Sciences: 321.22 – Urology and andrology

Abstract

Thesis structure: the work is presented on 103 pages and includes: introduction, 5 chapters with a synthesis of the results, conclusions and recommendations, bibliography, which cites 151 source, 33 tables, 39 figures, 6 annexes. The results obtained were reported in 19 scientific publications, including 2 with impact factor. Keywords: bladder tumors, NMIBC, cystoscopy, WL, narrow band imaging, NBI, transurethral resection, TUR-V, En-bloc resection, tumor recurrence, laser. Field of study: 321.22 – Urology and andrology. Purpose: clinico-morphological evaluation of the treatment of non-muscle-invasive bladder tumors for the optimization of endourological diagnostic and treatment methods. Research objectives: study of clinical and paraclinical aspects of NMIBC; comparative evaluation of the methods of early diagnosis of NMIBC by narrow band imaging (NBI) cystoscopy and white light cystoscopy (WL); comparative analysis of the quality of the histopathological results according to the applied surgical technique; comparative study of the results of treatment of NMIBC by transurethral resection (TUR-V) and En-bloc resection; development of the algorithm for prognosis of recurrences in patients with NMIBC. Scientific novelty and originality: based on the accumulated clinical material, a multilateral comparative analysis was performed on the results of early diagnosis, and the effectiveness of various endoscopic treatment methods (En-bloc resection and TUR-V) applied to patients with NMIBC was estimated; the value and superiority of using the new method of endourological diagnosis of NMIBC were demonstrated. Was determined the correlation between the number of tumors detected and the method of cystoscopy used (WL vs NBI); the methodology for performing the En-bloc resection method was argued, and the effectiveness of these interventions in patients with NMIBC was demonstrated; a complex analysis of the morphopathological results was carried out, indicating the importance of the presence in the histological piece of the detrusor muscle layer for the precise establishment of the diagnosis. Also, the correlation between the transurethral resection method applied and the number of recurrent tumors was established. The scientific problem solved by the study: the use NBI cystoscopy, compared with WL cystoscopy, has been shown to allow the determination of more tumor lesions and increase the early detection of primary tumors and tumor recurrences. Based on the comparative analysis of the treatment methods (En-bloc resection and TUR-V), several advantages of the En-bloc resection intervention were deduced, especially concerning the quality of the histopathological material collected and the rate of postoperative recurrences. Factors with prognostic value for assessing the probability of postoperative recurrences were identified. Theoretical significance and application value of the work: the value of complex clinical and paraclinical evaluation of patients with NMIBC to predict recurrence and disease progression was demonstrated. The implementation in clinical practice of new transurethral endoscopic methods of diagnosis with the use of NBI allowed the early detection of primary and recurrent tumors. The implementation and use of transurethral endoscopic intervention of En-bloc resection in the treatment of this urological pathology improved the postoperative results with a reduction of the recurrence rate, especially in the initial resection area. It has been shown that the accuracy of the established diagnosis depends on the presence of the detrusor (muscle layer) in the material for histopathological examination, which serves as a marker of the quality of the performed resection. Prognostic factors were identified that argued for the development of a predictive model for determining the probability of recurrence in patients with NMIBC, depending on the location of the tumor process and the surgical method of treatment applied. Implementation of scientific results: the results of the thesis were implemented in the didactic and curative process at the Department of Urology and Surgical Nephrology, SUMP „Nicolae Testemitanu”, Urology, Dialysis and Renal Transplant Clinic, from the Republican Clinical Hospital „Timofei Mosneaga” and other urology departments of Republic of Moldova.