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Eighty per cent of bladder tumours can be treated by endoscopic resection of the tumour if the urological surgeon is proficient in this technique. The survival of patients having this treatment is better than more radical surgery in all grades and in all stages except stages C and D.

The indications for endoscopic surgery vary within wide limits, depending chiefly upon the surgeon who is to perform the operation. If he has had adequate training and extensive experience in endoscopic surgery, the indications for him will include the removal of prostates weighing up to 150 to 200 grams, the resection of bladder tumors as large as 4 to 5 cm. in diameter, the crushing of stones up to 3 to 4 cm. in diameter and other procedures which are technically difficult. Surgeons who have not had this extensive training and experience, or who are unequipped in other ways to perform the more difficult endoscopic procedures, will limit the use of this approach to the small sized lesions. If a surgeon has had no training or experience in endoscopic surgery, there is no indication for its use by him; it is better for him not to attempt it. For the average urologist, endoscopic surgery is indicated for relief of bladder neck obstruction due to prostatic carcinoma which does not respond to hormone therapy and for removal of bladder neck contractures, median bars and the smaller prostatic adenomas. Small bladder tumors, small stones and sometimes Hunner ulcers and other intravesical lesions can usually be removed more successfully by the average urologist through the endoscopic approach than by open surgery. The ultimate factor determining the approach best suited to a given case is the operator himself. If he has established proficiency at removing large prostates and other lesions endoscopically, there is no contraindication to continuance of this method in his hands.

The introduction of a new surgical procedure or technique is always hailed by a volley of conflicting opinions regarding its application, and considerable time must elapse before its acceptance becomes general and its indications standardized. Factional disparity has been particularly rife in the history of endoscopic prostatic surgery, ranging from the operator who finds almost no indications for the transurethral approach to the one who treats practically one hundred per cent of his cases by this means. The younger generation of urologists is more enthusiastic about endoscopic prostatic surgery than are its elders, and men who have been schooled in centers where this operation is in current usage are more ardent supporters than those who have served their apprenticeship where the older types of prostatectomy prevail. Thus, a urologist’s training is the prime influence which molds his judgment concerning the relative merit of the different operative methods.