Thulium laser en bloc resection versus conventional transurethral resection of urinary bladder tumor: A comparative prospective study

Abstract

Background: Transurethral resection of bladder tumors (TURBT) is the standard management for urinary bladder tumors; however, new techniques as Thulium laser en bloc resection of bladder tumors (TmLRBT) have been introduced as a substitute to TURBT. Objectives: In this study safety, efficacy, and tumor recurrence after TmLRBT and TURBT were prospectively compared in patients with primary (<4 cm) bladder tumors. Patients and Methods: Between August 2019 and May 2021, patients with primary (<4 cm) bladder tumors were enrolled. Patients were randomized between the two procedures. All perioperative data were collected prospectively. Pathological specimen findings and recurrence rates were reported during follow-up visits. Results: Sixty patients underwent TURBT, and another 60 had TmLRBT. No significant differences were detected in patient demographics or preoperative tumor characteristics between the two groups. Operation time was less (28.2 vs. 38.9 min, P < 0.001), and rate of bladder perforation was lower with TmLRBT compared to TURBT (3.3% vs. 15.0%, P = 0.027). In the TmLRBT group, higher rate of muscle detection (95.0% vs. 78.3%, P < 0.001) in the pathological specimen, and lower rate of tissue destruction (0.0% vs. 21.6%, P < 0.001) were obtained compared to TURBT. Recurrence rate in cases of nonmuscle invasive bladder cancer was lower with TmLRBT (6.7% vs. 33.0%, P < 0.001). Conclusion: In this study, TmLRBT showed reduced operative time with lower perforation rates. Higher detection of detrusor muscle and less tissue destruction in the pathological specimen were obtained with TmLRBT, as well as lower rates of tumor recurrence. These findings suggest that TmLRBT is a safe and efficacious substitute to TURBT in tumors <4 cm.

Safety, feasibility, and quality of thulium laser en-bloc resection for treatment of non-muscle invasive bladder cancer

“…Relatedly, Badway et al have attempted to assess the feasibility of TmL-ERBT for tumours ˂ 4 cm in comparison to cTURBT and have found that TmL-ERBT is associated with a shorter operative time, a higher detrusor muscle detection rate, and a lower recurrence rate than cTURBT [ 16 ].…”

Comparative Analysis of En-Bloc and Conventional Transurethral Resection of Bladder Tumor (TURBT) for Non-Muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

“…Y. Zhang et al, 2017) The HT of patients treated with ERBT was considerably lower than that of patients treated with cTURBT, the mean difference (MD) was -0.85, in favor of ERBT (random effect, 95% confidence interval (CI)[-1.36, -0.34]; I 2 = 98%; P = 0.001). Likewise, 11 studies (Badawy et al, 2023;Chen et al, 2016;X. Chen et al, 2015;D'Souza & Verma, 2016;Huang et al, 2016;H.…”

“…Chen et al, 2015;Hashem et al, 2021;H. Liu et al, 2013), seven studies were prospective (Badawy et al, 2023 Hospitalization duration was documented in ten studies, catheterization duration in eleven studies, and operative duration in twelve studies. In accordance with ten studies (Badawy et al, 2023;Chen et al, 2016;X.…”

“…There was a substantial difference in the incidence of reflex nerve obturator between patients who received ERBT and those who had conventional TURBT. (Badawy et al, 2023;J. Chen et al, 2016;X.…”

En Bloc Resection of Bladder Tumors (ERBT) using different lasers – Hybrid and Holmium Laser

“…Recent studies have shown that ERBT offers better pathological analysis and oncological outcomes ( 3 - 6 ). Thulium and holmium are the most frequently used lasers for this procedure, with the hybrid laser being a new addition that combines thulium and diode to improve hemostatic properties ( 5 , 7 - 9 ).…”