A retrospective comparison of thulium laser en bloc resection of bladder tumor and plasmakinetic transurethral resection of bladder tumor in primary non-muscle invasive bladder cancer

Abstract

Bladder cancer is currently considered the most common malignancy of the urinary tract. Thulium laser en bloc resection of bladder tumor (TmLRBT) and plasmakinetic transurethral resection of bladder tumor (PK-TURBT) are two alternative common procedures used in our department to manage patients with primary non-muscle invasive bladder cancer (NMIBC) over the past decade. In this work, the safety and efficacy of TmLRBT were retrospectively compared to those of PK-TURBT in patients with primary NMIBC. From January 2013 to December 2015, 256 patients diagnosed with primary NMIBC were selected for this retrospective study. A total of 136 consecutive patients diagnosed with primary NMIBC were enrolled in the TmLRBT group. A similar historical cohort of 120 consecutive patients who underwent PK-TURBT was used to compare the two procedures. Clinical data, including age, gender, tumor characteristics, operation duration, hospitalization, irrigation, catheterization, and intraoperative and postoperative complications, were recorded. There were no significant differences in age, gender, mean tumor size, mean tumor number, tumor location, or risk between the TmLRBT and PK-TURBT groups. The TmLRBT group was associated with a significantly shorter operation duration (25.96 ± 21.19 min vs 37.18 ± 25.77 min, P = 0.018) and a shorter hospitalization time (3.11 ± 1.05 days vs 5.24 ± 2.06 days, P = 0.036). The postoperative irrigation time (6.33 ± 4.05 h vs 14.76 ± 6.28 h, P = 0.027) and catheterization time (2.03 ± 1.61 days vs 4.27 ± 1.17 days, P = 0.035) in the TmLRBT group were lower than those in the PK-TURBT group. No significant differences in fever and rebleeding were found in the TmLRBT and PK-TURBT groups. There were no significant differences in the overall, low-risk, intermediate-risk, and high-risk recurrence-free rates between the two groups (P = 0.43, P = 0.68, P = 0.71, and P = 0.24, respectively). The proportion of bladder detrusor muscle (BDM) identified in pathologic specimens of the TmLRBT group was higher than that in the PK-TURBT group (P = 0.006). TmLRBT may reduce operation duration time, hospitalization time, postoperative irrigation time, and catheterization time. TmLRBT is considered safer and more effective in treating primary NMIBC. Recurrence-free rates did not differ between groups.

Technical developments in transurethral resection of bladder tumours

“…Also, the rate of bladder detrusor muscle identified in pathologic specimens was higher in patients operated by laser. However, no differences in fever, bleeding, and recurrence-free rates were observed [60].…”

Safety and efficacy of en bloc transurethral resection versus conventional transurethral resection for primary nonmuscle-invasive bladder cancer：a meta-analysis

“…Fig.1 summarized the inclusion process. We performed intravesical chemotherapy or Bacille Calmette-Guerin BCG for postoperative patients, mitomycin was used in 5 studies [8,9,[15][16][17], epirubicin was used in 7 studies [6,7,10,12,14,23,24], pirarubicin was used in 5 studies [13,18,[20][21][22], BCG was used in 1 study [11] and BCG combined epirubicin [19] was used in 1 study.…”

“…Furthermore, 11 non-randomised studies [6,8,9,11,[15][16][17][20][21][22]24] were considered of high quality due to the score ≥7 stars ( Table 2). While there was a high heterogeneity in all comparisons, which may come from the patient demographics, difference in types of surgery and tumor characteristics.…”

“…HybridKnife, needle electrode and laser are the main methods for EBRT. A series of studies comparing EBRT and CTURBT have been reported [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Although the clinical recurrence rate between two approaches is controversial, less intraoperative and postoperative complications have been observed when undergoing EBRT.…”

Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries

“…Furthermore, monopolar transurethral resection of bladder tumors (TURB) has been the standard approach for pathologic diagnosis and staging [3]. However, several reported drawbacks, such as absence of detrusor muscle in the specimen, thermal damage to surrounding tissues, and risk of tumor cell seeding, have prompted surgeons to develop novel alternative procedures to improve the quality of resection [7,8]. To overcome the potential limitations of conventional TURB, en bloc resection and plasmakinetic TURB were incorporated into clinical practice.…”