Guidewire-assisted en bloc resection of periorifice non-muscle-invasive bladder cancer: a retrospective case series

Abstract Background En bloc resection of bladder tumor provides improved specimen quality compared with conventional transurethral resection of bladder tumor; however, periorifice tumors remain technically challenging due to the risk of ureteral injury. We reviewed the perioperative and short-term outcomes of patients who underwent guidewire-assisted en bloc resection for periorifice non-muscle-invasive bladder cancer. Methods In this retrospective case series, we included patients with non-muscle-invasive bladder cancer located within 1 cm of the ureteral orifice who underwent guidewire-assisted en bloc resection of bladder tumors between May 2024 and October 2025. A guidewire was inserted into the ipsilateral ureter before en bloc laser resection. Perioperative outcomes, pathological findings, postoperative complications, and follow-up data were collected and descriptively analyzed. Results Eleven patients who underwent guidewire-assisted ERBT were included in the final analysis. The median operative time was 26 min. No bladder perforation or obturator nerve reflex was observed in any patient. Minor bleeding was observed in three patients. The detrusor muscle was present, and the surgical margins were negative in all specimens. Histopathology revealed Ta disease in nine patients and T1 disease in two patients, with low-grade tumors present in nine cases and high-grade tumors in two. A ureteral stent was placed in one patient. During a median follow-up of 9 months (range: 3–18 months), no tumor recurrence or ureteral obstruction was detected. Conclusions In this retrospective case series, patients who underwent guidewire-assisted en bloc resection of bladder tumor had acceptable perioperative outcomes, with no major ureteral complications observed during short-term follow-up. Larger prospective studies are needed to further evaluate its perioperative, functional, and long-term oncologic outcomes.