Efficacy and Safety of Transurethral Laser Surgery Versus Transurethral Resection for Non-Muscle-Invasive Bladder Cancer: A Meta-Analysis and Systematic Review

Abstract

Objective: To compare the efficacy and safety of transurethral laser surgery and transurethral resection of a bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC). Material and Methods: A research was carried out in Medline via PubMed, EMBASE, the Cochrane Library, and Web of Science up to October 20, 2019, to identify articles related to transurethral laser surgery and TURBT for NMIBC. All analyses were done using RevMan5.3 and Stata14. Results: A total of 17 studies involving 2,439 participants were included. The analysis showed no significant difference in operation times (mean difference =-0.2; 95% CI-2.29 to 1.89; p = 0.85) or occurrences of urethral stricture (OR = 0.7; 95% CI 0.24-2.06; p = 0.52). Transurethral laser surgery was associated with a lower incidence of obturator nerve reflex (OR = 0.04; 95% CI 0.02-0.09; p < 0.00001) and bladder perforation (OR = 0.09; 95% CI 0.04-0.23; p < 0.00001), a higher rate of detrusor muscle acquisition (OR = 5.28; 95% CI 2.42-11.49; p < 0.0001), shorter catheterization (mean difference =-1.05; 95% CI-1.41 to-0.68; p < 0.00001) and hospitalization times (mean difference =-0.96; 95% CI-1.59 to-0.33; p = 0.003), and lower rates of bladder irrigation (OR = 0.21; 95% CI 0.13-0.35; p < 0.00001) and recurrence both at 12 months (OR = 0.66; 95% CI 0.48-0.9, p = 0.008) and at 24 months (OR = 0.6; 95% CI 0.41-0.86; p = 0.005). Conclusions: Transurethral laser surgery for NMIBC, as compared to TURBT, is associated with a lower incidence of complications, a lower recurrence rate, and faster postoperative recovery.

Comparative efficacy and safety of transurethral laser surgery with holmium laser, KTP laser, 2-micron laser or thulium laser for the treatment of non-muscle invasive bladder carcinoma: a protocol of network meta-analysis

“… 14 15 Four types of lasers have been widely used in transurethral laser therapy for NMIBC, 16 however it is unclear which types of laser may be optimal because previous direct meta-analysis only separately compared individual type of laser with standard transurethral resection by conducting subgroup analysis. 15 Certainly, it cannot obtain comprehensive comparative efficacy and safety of four types of laser due to the nature of conventional direct meta-analysis. 17 Therefore, it is imperative to conduct a network meta-analysis which is an expansion of conventional direct meta-analysis and has the ability of simultaneously comparing multiple treatments (more than two) at one time and calculating rank probabilities of all treatments 18 19 to further determine the optimal type of laser for the treatment of NMIBC.…”

“…However, several kind of lasers including holmium laser, potassium titanylphosphate (KTP) laser, 2-micron laser and thulium laser have been found to be useful in transurethral laser therapy for NMIBC, 16 and the possible associations of these four types of lasers are displayed in figure 1. Although, meta-analysis performed by Xu and colleagues separately investigated the comparative efficacy and safety between different transurethral laser surgeries and standard transurethral resection through performing subgroup analysis, 15 it remains unclear which types of laser should be preferentially selected owing to the nature of conventional direct meta-analysis. 17 As an expansion of conventional direct meta-analysis, network meta-analysis has the ability of simultaneously comparing multiple treatments at a time.…”

The efficacy and safety of thulium laser resection of bladder tumor versus standard transurethral resection in patients with non muscle-invasive bladder cancer: a systematic review and meta-analysis

“…Fortunately, the applications of laser therapy techniques have provided an alternative method in terms of NMIBC treatment. Recently, a meta-analysis published by Xu et al [29] reported a lower incidence of complications, less probability of recurrence and faster postoperative recovery in laser operation group for patients with NMIBC when comparing to TURBT. However, different type of laser has distinct characteristic and may result in diverse outcome.…”

1470 nm/980 nm dual-wavelength laser is safe and efficient for the en-bloc resection of non-muscle invasive bladder cancer: A propensity score-matched analysis

“…A previous meta-analysis conducted on a total of 17 studies consisting of 2439 participants suggested that laser surgery demonstrated a lower chance of causing complications, such as obturator nerve reflex and bladder perforation. 23 During the TURBT operation, the current frequently released by the electrode loop may stimulate the obturator nerves near the inferolateral bladder wall, bladder neck and lateral prostatic urethra, thus causing the adductor muscles to contract abruptly, leading to secondary bladder perforation. 24 The 1470 nm/980 nm dual-wavelength laser system uses a specialty optical fibre to emit and transmit the laser, which is in turn absorbed by tissues and produces vaporization, cutting and coagulation effects.…”