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Bladder cancer — USMLE Step 2 CK MCQ

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HardSurgeryBladder cancerUSMLE Step 2 CK

A 66-year-old man with a 40-pack-year smoking history has painless gross hematuria. CT urography shows a 2.4-cm papillary lesion arising from the lateral bladder wall without hydronephrosis or metastatic disease. Office cystoscopy confirms the lesion. Which procedure is required next to establish diagnosis and local stage?

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Correct answer: A — Complete transurethral resection including detrusor muscle sampling

The best answer is “Complete transurethral resection including detrusor muscle sampling”. A visible bladder tumor is diagnosed and initially staged by complete transurethral resection. Sampling detrusor muscle is critical for distinguishing non-muscle-invasive from muscle-invasive disease and determining subsequent intravesical treatment, repeat resection, or cystectomy. Cytology cannot provide local stage, and percutaneous biopsy risks tumor seeding. Radical cystectomy and intravesical therapy are selected only after histologic grade and depth of invasion are known.

Reference: AUA/SUFU guideline: non-muscle-invasive bladder cancer. https://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-muscle-invasive-guideline