Holmium laser transurethral resection of bladder tumor: Our experience

Abstract

Purpose:To compare the safety and efficiency of conventional monopolar and holmium laser en bloc transurethral resection of bladder tumor (CM-TURBT and HoL-EBRBT) while managing primary nonmuscle-invasive bladder cancer.Materials and Methods:From January 2012 to October 2015, fifty patients with primary nonmuscle-invasive bladder cancer underwent endoscopic surgery. Among them, 27 patients underwent CM-TURBT and 23 patients underwent HoL-EBRBT. Clinical data, included preoperative, operative, and postoperative management and follow-up, were recorded.Results:Patient demographics and tumor characteristics in both groups were compared before surgery. There was no significant difference in operative duration among the groups. Compared with the CM-TURBT group, HoL-EBRBT group had less intraoperative and postoperative complications, including obturator nerve reflex (P < 0.01), bladder perforation (P < 0.01), as well as bleeding and postoperative bladder irritation (P < 0.01). There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoL-EBRBT group had less catheterization and hospitalization time than those in the CM-TURBT group (P < 0.01), and there were no significant differences in each risk subgroup as well as the overall recurrence rate among the CM-TURBT and HoL-EBRBT groups.Conclusions:HoL-EBRBT might prove to be preferable alternatives to CM-TURBT management of nonmuscle-invasive bladder cancer. HoL-EBRBT however did not demonstrate an obvious advantage over CM-TURBT in tumor recurrence rate.

Technical developments in transurethral resection of bladder tumours

“…In the next study on 27 patients after mTURB and 23 patients after HoLRBT, the authors showed that there were no significant differences in operation time and recurrence rates between the two groups. The HoLRBT group had lower intraoperative and postoperative complication rates, but there were no significant differences in the transfusion rates and occurrence of urethral strictures [45].…”

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.…”

Therapeutic use of lasers in urology

“…Podejmowane są próby leczenia nienaciekających raków pęcherza moczowego (non-muscle-invasive bladder tumour -NMIBC) z użyciem lasera holmowego i tulowego, aczkolwiek zgodnie z obowiązującymi wytycznymi międzynarodowych towarzystw urologicznych przezcewkowa elektroresekcja guza pęcherza moczowego (transurethral resection of bladder tumour -TURBT) wciąż pozostaje tzw. złotym standardem [4][5][6]. Opublikowano również prace dotyczące zastosowania lasera holmowego i diodowego w częściowej nefrektomii, należy jednak uznawać to wciąż za metodę eksperymentalną, której skuteczność wymaga potwierdzenia w dalszych badaniach [7][8][9].…”