1
|
Choudhury S, Ahmed S, Sasmal S, Patel P. En-bloc resection of non-muscle invasive urinary bladder tumors using low power Holmium laser-A new promise. Urologia 2024:3915603241277914. [PMID: 39230520 DOI: 10.1177/03915603241277914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been initially managed with conventional trans-urethral resection of urinary bladder tumors (cTURBT) which has certain drawbacks and complications. Efforts have been made to find newer methods for management. In this study, we have used low power Holmium laser en-bloc resection and have assessed its safety, efficacy and feasibility. MATERIALS AND METHODS Forty patients have been included in this prospective observational study who underwent low power Holmium laser en-bloc resection of urinary bladder tumor after taking Institutional ethical committee clearance and informed consent from all the patients. Intra-operative and post-operative data were collected. RESULTS The average tumor size was 21.68 ± 9.55 mm. Out of those, 65% of the patients had a tumor less than 3 cm in size. Fourteen patients (35%) had tumors at multiple sites. The average duration of resection per tumor was 24.84 ± 6.83 min. None of the cases required conversion to cTURBT. There was no obturator reflex or urinary bladder perforation in any of the cases. Detrusor muscle was present in the histopathology reports of 92.5% patients. The average duration of catheterization was 1.82 ± 0.61 days. CONCLUSION For NMIBC's, low power Holmium laser en-bloc resection is a safe procedure with minimum risk of complications. High rate of detrusor-positive specimens indicates its efficacy and feasibility.
Collapse
Affiliation(s)
- Sunirmal Choudhury
- Department of Urology, Medical College and Hospital Kolkata, Kolkata, India
| | - Shahbaaz Ahmed
- Department of Urology, Medical College and Hospital Kolkata, Kolkata, India
| | - Surajit Sasmal
- Department of Urology, Medical College and Hospital Kolkata, Kolkata, India
| | - Prakhar Patel
- Department of Urology, Medical College and Hospital Kolkata, Kolkata, India
| |
Collapse
|
2
|
Zhou SC, Jin SY, Wang QY, Ren GK, Peng CG, Wang YB, Wu DK. Surgical flip-dislocation of the bicolumnar approach without olecranon osteotomy versus olecranon osteotomy in type AO 13C3 distal humeral fracture: a matched-cohort study. J Orthop Surg Res 2023; 18:913. [PMID: 38031095 PMCID: PMC10688126 DOI: 10.1186/s13018-023-04405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Our experience with the surgical flip-dislocation of the bicolumnar (SFDB) approach for type AO 13C3 humeral fractures indicates that this surgical approach can be performed safely and effectively in appropriately selected patients. We aimed to evaluate the clinical outcomes of the SFDB approach without olecranon osteotomy (OO) for type AO 13C3 distal humeral fractures. METHODS We retrospectively reviewed 65 cases of type AO 13C3 distal humeral fractures treated between April 2008 and July 2018; 33 patients were treated with the SFDB approach, and the remaining were treated with OO. Propensity score matching was used to control for sex, age, and the American Society of Anesthesiology score. Elbow pain, range of motion, stability, and function were assessed using the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Clinical complications, reoperation rates, and radiographic results were compared between the groups. RESULTS Operative time and blood loss were significantly lower in the SFDB group than in the OO group (P = 0.001, P = 0.002, respectively). At the final follow-up, the mean postoperative MEPI did not significantly differ between the groups (P = 0.628). According to Morrey's criteria, a typical functional range of elbow motion was achieved in 12 and 15 patients in the SFDB and OO groups, respectively. CONCLUSIONS The SFDB approach achieves superior exposure of the articular surface without injury to the extensor mechanism in type 13C3 articular surface fracture treatment. This approach also results in good early functional recovery and clinical outcomes, with a low risk of complications.
Collapse
Affiliation(s)
- Shi-Cheng Zhou
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Sheng-Yu Jin
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Qing-Yu Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Guang-Kai Ren
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Chuan-Gang Peng
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Yan-Bing Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China.
| | - Dan-Kai Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China.
| |
Collapse
|
3
|
Di Y, Li H, He C, Peng H. En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis. Actas Urol Esp 2023; 47:309-316. [PMID: 36319557 DOI: 10.1016/j.acuroe.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/28/2022] [Indexed: 06/05/2023]
Abstract
INTRODUCTION We performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. METHODS A systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. RESULTS En-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; p < 0.001), catheterization-time (MD: -0.66; 95%CI: -1.02-[-0.29]; p < 0.001), length of hospital stay (MD: -0.95; 95%CI: -1.55-[-0.34]; p = 0.002), postoperative bladder irrigation duration (MD: -6.06; 95%CI: -9.45-[-2.67]; p < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; p = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: p < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; p = 0.09), the operation time (MD: 0.67; 95%CI: -1.92 to 3.25; p = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; p = 0.0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. CONCLUSIONS En-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.
Collapse
Affiliation(s)
- Y Di
- Department of Urology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Heilongjiang, China
| | - H Li
- Department of Urology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Heilongjiang, China
| | - C He
- Department of Urology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Heilongjiang, China
| | - H Peng
- Department of Urology, The Fourth Hospital of Changsha, Hunan, China.
| |
Collapse
|
4
|
Wang CW, Lee PJ, Wu CW, Ho CH. Comparison of Pathological Outcome and Recurrence Rate between En Bloc Transurethral Resection of Bladder Tumor and Conventional Transurethral Resection: A Meta-Analysis. Cancers (Basel) 2023; 15:cancers15072055. [PMID: 37046715 PMCID: PMC10093679 DOI: 10.3390/cancers15072055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Current treatment for non-muscle invasive bladder cancer (NMIBC) is the conventional transurethral resection of bladder tumor (CTURBT), but the en bloc transurethral resection of bladder tumor (ERBT) has been gaining more attraction in recent years considering better specimen integrity. Thus, we conducted this meta-analysis to compare the safety and efficacy of ERBT versus CTURBT. Trials were collected from an online database. The primary outcomes included identification of detrusor muscle in specimen, residual tumor, 3, 12, and 24-month recurrence rates and same-site recurrence rate. A total of 31 trials were included. The ERBT group had a higher rate of identification of detrusor muscle in specimens (p = 0.003) and lower residual tumor (p < 0.001). Other than that, lower rates of 3-month (p = 0.005) and 24-month recurrence rate (p < 0.001), same-site recurrence rate (p < 0.001) and complications were also observed. For perioperative outcomes, shorter hospitalization time (HT) (p < 0.001), and catheterization time (CT) (p < 0.001) were also revealed in the ERBT group. No significant difference was found in operative time (OT) (p = 0.93). The use of ERBT showed better pathological outcomes and fewer complications, so it could be considered a more effective treatment option for NMIBC.
Collapse
|
5
|
O'Sullivan NJ, MacCraith E, Temperley HC, Naughton A, Davis NF. Standard Transurethral Resection vs Transurethral Laser Surgery for Bladder Cancer: A Systematic Review and Meta-Analysis Comparing Clinical Outcomes and Complications. J Endourol 2023; 37:304-315. [PMID: 36367162 DOI: 10.1089/end.2022.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Transurethral resection of bladder tumor (TURBT) remains the gold standard method of diagnosing and treating nonmuscle invasive bladder cancer. Laser resection has been demonstrated as a safe and efficacious alternative; however, its mainstream use remains limited. The aim of this review is to comparatively evaluate clinical outcomes of TURBT and laser resection of bladder tumor (LRBT) for bladder cancer. Methods: A systematic review of the literature was performed for studies comparing TURBT and LRBT for bladder cancer. Outcome measurements were recurrence rates, complication rates, patient demographics, operative duration, and inpatient stay. Meta-analysis was performed using Review Manager 5. Results: Twenty studies on 2621 patients (n = 1364 for TURBT and n = 1257 for LRBT) met inclusion criteria. Demographics, including age and gender ratio and follow-up period, were similar in both groups. Recurrence rates were similar between TURBT and LRBT (29.1% vs 28.2%, p = 0.12). TURBT had a significantly greater obturator kick rate (11.5% vs 0.4%, p < 0.0001) and perforation rate (3.7% vs 0.009%, p = < 0.0001). In the six studies which reported on presence of detrusor muscle in the specimen, it was significantly greater in the LRBT group (96.6% vs 88.1%, p = 0.01). There was no significant difference in operative time between the two groups. TURBT was associated with a significantly longer catheter duration (mean difference [MD] 0.98 days shorter in LBRT group; 95% confidence interval [95% CI] -1.45 to -0.5, p = < 0.00001), and length of stay (MD 1.12 days shorter in LRBT group, 95% CI -1.7 to -0.54, p = 0.0001). Conclusions: LRBT for bladder cancer has the benefit of reduced catheter duration, length of stay, and perforation without impacting negatively on operation duration, recurrence rates, or specimen quality.
Collapse
Affiliation(s)
| | - Eoin MacCraith
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | | | - Ailish Naughton
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons, Ireland
| |
Collapse
|
6
|
El-Karamany TM, Al-Adl AM, Hosny MM, A Eldeep H, El-Hamshary SA. Clinical utility of vesical imaging-reporting and data system (VI-RADS) in non-muscle invasive bladder cancer (NMIBC) patients candidate for en-bloc transurethral resection: A prospective study. Urol Oncol 2022; 40:454.e1-454.e7. [PMID: 35466036 DOI: 10.1016/j.urolonc.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess accuracy of vesical imaging-reporting and data system (VI-RADS) 5-point score in detection of muscle invasive bladder cancer and avoiding second look transurethral resection of the tumors (TURBT). Additionally, to assess safety and efficacy of bipolar en-block transurethral urethral resection of bladder tumor. METHODS Patients with bladder mass up to 5 cm were included in the study. VI-RADS 5-point score was done preoperative for all cases and postoperatively before second look TURBT. Patients were followed up for 12 months. RESULTS In all, 80 cases were eligible for the study. Preoperative VI-RADS score at cutoff of 3 had sensitivity of 89.3 %, specificity 83.3 %, postive predective value (PPV) 92.6 %, negative predictive value (NPV) 76.9 %, accuracy of 87.5 %, while at cutoff 2 sensitivity was 82.1%, specificity 91.7%, PPV 95.8%, NPV 68.8%, accuracy of 85.0%. Operative time 28.8 ± 9.4 minutes, hemoglobin drop 0.3 ± 0.05 g/dl, catheterization time 2.8 ± 0.8 days, hospital stay 1.4 ± 0.4 days. No complications occurred. Recurrence in field of resection 3.75%. Detrusor muscle was available in 76 cases (95%). Postoperative VI-RADS score at cutoff of 3 had sensitivity of 78.6%, specificity 77.8%, PPV 84.6%, NPV 70.0%, accuracy of 78.3%. At cutoff 2 VI-RADS score sensitivity was 71.4%, specificity 77.8%, PPV 83.3%, NPV 63.6%, accuracy of 73.9%. CONCLUSION VI-RADS 5-point score showed high sensitivity and specificity in preoperative discrimination of non-muscle invasive bladder cancer (NMIBC) from muscle invasive bladder cancer cases and in avoiding unnecessary second look TURBT. Bipolar en-block TURBT technique is both safe and efficacious in resecting NMIBC cases with low recurrence rate.
Collapse
|
7
|
Resección transuretral en bloque vs. resección transuretral convencional para el cáncer de vejiga primario no músculo-infiltrante: metaanálisis. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Symeonidis EN, Lo KL, Chui KL, Vakalopoulos I, Sountoulides P. En bloc resection of bladder tumors: challenges and unmet needs in 2021. Future Oncol 2022; 18:2545-2558. [PMID: 35642479 DOI: 10.2217/fon-2021-1228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Non-muscle invasive bladder cancer accounts for the majority of new bladder cancer diagnoses, and endoscopic transurethral resection of bladder tumor (TURBT) represents the standard-of-care. Although a relatively safe and common procedure, TURBT is often hampered by the questionable quality of resection. The evolution of surgical techniques has brought en bloc resection of bladder tumor (ERBT) to the forefront. ERBT has emerged as an alternative to conventional TURBT, incorporating a more delicate en bloc sculpting and tumor excision, in contrast to 'piecemeal' resection by conventional TURBT. ERBT appears safe, feasible and effective with demonstrably higher rates of detrusor muscle in the pathologic specimen, all while providing better staging and obviating the need for a re-TURBT in selected patients. However, the method's adoption in the field is still limited. This review summarizes the recent evidence relevant to ERBT while further highlighting the technique's limitations and unmet needs.
Collapse
Affiliation(s)
- Evangelos N Symeonidis
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| | - Ka-Lun Lo
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Ka-Lun Chui
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Ioannis Vakalopoulos
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| | - Petros Sountoulides
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| |
Collapse
|
9
|
Oswald D, Pallauf P, Deininger S, Herrmann TRW, Netsch C, Becker B, Fiedler M, Haecker A, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Gross AJ, Westphal J, Lusuardi L. [Safety and efficacy of en bloc vs. conventional transurethral resection of bladder tumors: a meta-analysis and systematic review]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:644-652. [PMID: 35286433 DOI: 10.1007/s00120-022-01765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. OBJECTIVE To analyze current data on ERBT in efficacy and safety compared to cTURBT. DATA SOURCES PubMed. STUDY SELECTION Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. DATA SYNTHESIS The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. CONCLUSION ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.
Collapse
Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - P Pallauf
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | | | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - M Fiedler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Haecker
- Klinik für Urologie und Kinderurologie, Gesundheitsverbund Landkreis Konstanz, Klinikum Konstanz, Konstanz, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologische Klinik am Lerchenberg, Heilbronn, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - J Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| |
Collapse
|
10
|
Comparison of various types of lasers and transurethral resection in the treatment of bladder tumors: a systematic review and meta-analysis. Lasers Med Sci 2022; 37:95-101. [PMID: 35022872 DOI: 10.1007/s10103-021-03479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
Bladder cancer is one of the most common cancers of the urinary tract. The two available treatments for this malignancy are laser and Transurethral Resection of the Bladder Tumor (TURBT). The aim of this study was to compare the different parameters of these two methods. A systematic search was performed on PubMed, Scopus and Google Scholar between 2000 and 2021. All articles related to non-muscle invasive bladder cancer (NMIBC) were extracted. All analyses were performed using R-studio statistical software version 1.0.136. In total, 11 studies that reported tumor recurrence in two methods were evaluated. A total of 626 and 742 patients were treated with laser and TURBT, respectively. Tumor recurrence, duration of operation, hospitalization and catheterization in laser therapy were significantly lower than TURBT. In addition, the incidence of complications was lower in patients treated with laser. The incidence of obturator nerve reflex, bladder perforation and postoperative bladder irrigation was significantly higher in patients treated with TURBT. Only in relation to postoperative urethral stricture, no significant difference was observed between the two treatment methods. Laser therapy compared to TURBT in patients with NMIBC has fewer complications and faster recovery. Also, the risk of tumor recurrence in laser therapy is less than TURBT.
Collapse
|
11
|
Schuettfort VM, Pradere B, Compérat E, Abufaraj M, Shariat SF. Novel transurethral resection technologies and training modalities in the management of nonmuscle invasive bladder cancer: a comprehensive review. Curr Opin Urol 2021; 31:324-331. [PMID: 33973535 DOI: 10.1097/mou.0000000000000892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Conventional transurethral resection (TURBT) with tumor fragmentation is the primary step in the surgical treatment of nonmuscle invasive bladder cancer. Recently, new surgical techniques and training modalities have emerged with the aim to overcome short-comings of TURBT and improve oncologic outcomes. In this review, we provide a comprehensive update of recent techniques/techniques that aim to improve upon conventional TURBT and beyond. RECENT FINDINGS A systemic approach during conventional TURBT that features the use of a surgical checklist has been shown to improve recurrence-free survival. Several simulators have been developed and validated to provide additional training opportunities. However, transfer of improved simulator performance into real world surgery still requires validation. While there is no convincing data that demonstrate superior outcomes with bipolar TURBT, en-bloc resection already promises to offer lower rates of complications as well as potentially lower recurrence probabilities in select patients. SUMMARY TURBT remains the quintessential procedure for the diagnosis and treatment of bladder cancer. Urologists need to be aware of the importance and challenges of this procedure. Aside of embracing new resection techniques and a conceptual-systematic approach, training opportunities should be expanded upon to improve patient outcomes.
Collapse
Affiliation(s)
- Victor M Schuettfort
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Eva Compérat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- European Association of Urology Research Foundation, Arnhem, The Netherlands
| |
Collapse
|
12
|
Kopel J, Sharma P. En bloc transurethral resection of bladder tumor: A review of the literature. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415821993734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bladder cancer remains one of the most common malignancies of the genitourinary tract. Transurethral resection of the bladder tumor (TURBT) via cystoscopy with examination under anesthesia remains the primary method for determining the diagnosis and clinical stage of bladder cancer. Given the substantial cost of treatment and risk of bladder cancer recurrence after TURBT, novel approaches to transurethral resection, such as the en bloc technique, have been developed in an attempt to address these limitations. In this review, we examined the postoperative and oncological outcomes of en bloc TURBT compared to traditional resection techniques. Further prospective clinical studies, however, are still necessary to determine whether these alternative technologies or surgical techniques may improve treatment in bladder cancer patients. Level of evidence: Not applicable.
Collapse
Affiliation(s)
- Jonathan Kopel
- Department of Urology, Texas Tech University Health Sciences Center, USA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, USA
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW En bloc resection of bladder tumor (ERBT) is an innovative new surgical technique, the use of which is becoming increasingly widespread. In this review, we analyze the recent literature and explore new developments, which may impact the future role of en bloc bladder surgery. RECENT FINDINGS ERBT increases the frequency with which detrusor muscle is present in the specimen (to 95%) and offers a significant improvement in the quality of the resection specimen, thereby helping with T1 substaging. Furthermore, the laser treatment reduces the rate of obturator nerve-related bladder perforation. SUMMARY ERBT represents a considerable advancement in the surgical management of nonmuscle-invasive bladder cancer. It delivers excellent oncological results and is a well tolerated procedure. VIDEO In the accompanying video, we shortly report the different modalities and energy sources used for bladder cancer resection. The three strategies are currently employed at the Fundació Puigvert (Barcelona). VIDEO ABSTRACT:.
Collapse
|
14
|
Abstract
The goals of transurethral resection of bladder tumour (TURBT) are to identify and eradicate visualized bladder tumour if technically safe and feasible and to obtain a specimen of satisfactory quality to enable accurate histological diagnosis. In the setting of high grade bladder tumour this generally entails the inclusion of detrusor muscle and assessment for the presence of associated carcinoma in situ (CIS), lymphovascular involvement or any variant form of bladder cancer. This will assist in determining risk stratification and prognostication of the bladder cancer and guides further treatment planning. Conversely, if suboptimal TURBT is performed there will be detrimental consequences on patient outcomes in regards to undergrading or understaging, increased recurrence or progression, and subsequently need for further treatments including more invasive interventions. This review article firstly summarises the key principles and complications of TURBT, as well as significance of re-TURBT. We also discuss a number of modifications and advances in detection technology and resection techniques that have shown to improve perioperative as well as pathological and oncological outcomes of bladder cancer. They include enhanced cystoscopy such as blue light cystoscopy (BLC), narrow band imaging (NBI) and en bloc resection of bladder tumour (ERBT) technique using various types of energy source.
Collapse
Affiliation(s)
- Lawrence H C Kim
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| |
Collapse
|
15
|
Maheshwari PN, Arora AM, Sane MS, Jadhao VG. Safety, feasibility, and quality of holmium laser en-bloc resection of nonmuscle invasive bladder tumors - A single-center experience. Indian J Urol 2020; 36:106-111. [PMID: 32549661 PMCID: PMC7279102 DOI: 10.4103/iju.iju_348_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Conventional transurethral resection of bladder tumor (cTURBT), despite its piecemeal resection and associated limitations, remains the most widely practiced technique of TURBT. Resecting the tumor in a single piece would avoid most of the drawbacks of cTURBT. Our objective was to assess the feasibility, safety, and quality of Holmium (Ho) laser en-bloc resection (ERBT) for nonmuscle-invasive bladder cancer (NMIBC). Materials and Methods: We retrospectively studied 67 patients who underwent Ho laser EBRT for primary NMIBC. Data were collected regarding tumor size, number and location, intraoperative complications, and postoperative course. Patients were grouped as first 20, next 20 (21–40), and last 27 cases to assess how the quality of resection improved with increasing experience. Results: The mean tumor size was 28.7 ± 7.9 mm, with 34.3% of the patients having a tumor larger than 3 cm. While 43 patients (64.17%) had a single tumor, the rest had multiple tumors, ranging from 2 to 9 in number. The mean total duration of resection was 38.7 ± 11.6 min. No case required conversion to cTURBT. No patient experienced obturator reflex or bladder perforation. Detrusor muscle was present in 85.07% of the resections. With increasing experience, requirement for bladder irrigation and the incidence of postoperative clot evacuation decreased (P < 0.0001 and P = 0.31, respectively), and the detrusor-positive rate in the specimen increased (P = 0.24). The mean duration of catheterization was 1.76 ± 0.54 days. Conclusion: Ho laser ERBT is safe and feasible for complete resection of NMIBCs with no risk of obturator-nerve reflex and a high rate of detrusor-positive specimens.
Collapse
Affiliation(s)
| | | | - Mahesh S Sane
- Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | | |
Collapse
|
16
|
Li C, Gao L, Zhang J, Yang X, Liu C. The effect of holmium laser resection versus standard transurethral resection on non-muscle-invasive bladder cancer: a systematic review and meta-analysis. Lasers Med Sci 2020; 35:1025-1034. [PMID: 32006262 DOI: 10.1007/s10103-020-02972-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2020] [Indexed: 01/11/2023]
Abstract
To explore the advantages and limitations of holmium laser resection of the bladder tumor (HOLRBT) versus standard transurethral resection of the bladder tumor (TURBT) in the treatment of non-muscle-invasive bladder cancer (NMIBC), the eligible studies were selected from the following databases: PubMed, Cochrane Library, and Embase. Studies comparing HOLRBT and TURBT for patients with NMIBC were included. The outcomes of interest were time of operation, catheterization and hospitalization, rates of recurrence, and perioperative complications, including obturator nerve reflex, bladder perforation, bladder irritation, and urethral stricture. Results of all data were compared and analyzed by Review Manager 5.3. A total of 9 comparative studies were finally included for this analysis. Pooled data demonstrated that HOLRBT significantly reduced the time to catheterization and hospitalization, the rate of recurrence in 2 years of follow-up, obturator nerve reflex, bladder perforation, and bladder irritation, compared with those in TURBT, respectively. However, no significant difference found between HOLRBT and TURBT in the time of operation, rate of recurrence in 1-year follow-up, and urethral stricture. The results of this research reached that HOLRBT would be a better choice than TURBT for patients with NMIBC.
Collapse
Affiliation(s)
- Changlong Li
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Liang Gao
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Jindong Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Xiaokang Yang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Chuan Liu
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China.
| |
Collapse
|
17
|
Yang H, Lin J, Gao P, He Z, Kuang X, Li X, Fu H, Du D. Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis. Urol Int 2020; 104:402-409. [PMID: 31910427 DOI: 10.1159/000503734] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND En bloc transurethral resection (ERBT) is a major topic of discussion as an alternative to conventional transurethral resection (cTURBT) for the treatment of non-muscle-invasive bladder cancer (NMIBC) addressing the limitations of cTURBT. METHODS We searched through electronic databases including Embase, Cochrane Library, MEDLINE, Web of Science, PubMed, and Google Scholar for articles published up to April 1, 2019; RevMan 5.3 was used to conduct this meta-analysis. Results were expressed as 95% confidence intervals (CI) and risk differences (RD). RESULTS Nine trials met the inclusion criteria (n = 1,020 patients): 1 study was a randomized controlled trial including a total of 142 participants, 4 studies had a prospective paired design including 605 patients, and 4 studies were retrospective (n = 273 patients). Duration of continuous postoperative bladder irrigation (RD -0.16; 95% CI -3.47 to 0.28; I2 = 97%; p = 0.10) and operation time (RD 0.05; 95% CI -0.23 to 0.32; I2 = 79%; p = 0.74) were not significantly different between ERBT and cTURBT. However, hospitalization time (I2 = 96%; χ2 = 203.16; p = 0.01) and catheterization time (I2 = 95%; χ2 = 163.24; p = 0.02), as well as 24-month recurrence rate (I2 = 0%; χ2 = 0.98; p = 0.008) were significantly better using the ERBT scheme. The incidence of urethral stricture between both schemes (95% CI -0.03 to 0.02; p = 0.50) was not different, but complications such as obturator nerve reflex (95% CI 0.01 to 0.12; p < 0.00001) and bladder perforation (95% CI 0.05 to 0.59; p = 0.50) were less frequent in the ERBT group. CONCLUSION ERBT is an effective treatment approach with some advantages for NMIBC. Our meta-analysis revealed that hospitalization time, catheterization time, and 24-month recurrence rate is superior in patients treated with ERBT than cTURBT, and ERBT patients also have a lower complication rate. Furthermore, ERBT improves the quality of tumor specimens and decreases the frequency of repeat transurethral bladder cancer resection. Further randomized controlled trials are needed to confirm our results.
Collapse
Affiliation(s)
- Han Yang
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Jingyu Lin
- Department of Gynecology and Obstetrics, Binhai Hospital, Tianjin Medical University General Hospital, Tianjin, China
| | - Pan Gao
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Ziqiu He
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Xiayu Kuang
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Xinyu Li
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Haibo Fu
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Dan Du
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China,
| |
Collapse
|
18
|
Zhang D, Yao L, Yu S, Cheng Y, Jiang J, Ma Q, Yan Z. Safety and efficacy of en bloc transurethral resection versus conventional transurethral resection for primary nonmuscle-invasive bladder cancer: a meta-analysis. World J Surg Oncol 2020; 18:4. [PMID: 31901243 PMCID: PMC6942380 DOI: 10.1186/s12957-019-1776-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/23/2019] [Indexed: 01/11/2023] Open
Abstract
Background The purpose of this meta-analysis is to compare the safety and efficacy of en bloc transurethral resection of bladder tumor (EBRT) versus conventional transurethral resection of bladder tumor (CTURBT). Methods We performed a meta-analysis of relevant articles through November 2019 using PubMed, Embase, and Cochrane Central Register to compare the safety and efficacy of EBRT versus CTURBT. The main endpoint included the operation time (OT), hospitalization time (HT), catheterization time (AT), perioperative period complications, bladder detrusor muscle found in the specimen, the residual tumor on the base, the ratio of the same site recurrence, and 12/24/36-month recurrence rate. Cochrane Collaboration’s Revman software, version 5.3, was used for statistical analysis. Results A total of 19 studies with 2651 patients were included, 1369 underwent EBRT and 1282 underwent CTURBT. Patients treated with EBRT had a significantly lower AT, HT, obturator nerve reflex, bladder perforation, bladder irritation, postoperative complications, and 24-month recurrence rate than those who underwent CTURBT. While no significant difference was found in terms of OT, the ratio of bladder detrusor muscle found in the specimen, the residual tumor on the base, 12-month recurrence rate, 36-month recurrence rate, and the ratio of the same site recurrence. In mitomycin subgroup, EBRT was superior to CTURBT in terms of 12/24-month recurrence rate. Similarly, in the prospective subgroup and retrospective subgroup, EBRT had a lower 24-month recurrence rate than CTURBT. However, no significant difference was found in the low, intermediate, and high-risk group in the light of 12–36-month recurrence rate. Conclusions Based on the included 19 articles, EBRT had a significantly lower AT, HT, intraoperative and postoperative complications, and 24-month recurrence rate than those treated with CTURBT. Well-designed randomized controlled trials were needed to reevaluate these outcomes. Trial registration This meta-analysis was reported in agreement with the PRISMA statement and was registered on PROSPERO 2019 CRD42019121673.
Collapse
Affiliation(s)
- Dong Zhang
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated Hospital of Zhejiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Lifeng Yao
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated Hospital of Zhejiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Sui Yu
- Department of Urology, Medical School of Ningbo University, Zhejiang, China
| | - Yue Cheng
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated Hospital of Zhejiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Junhui Jiang
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated Hospital of Zhejiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Qi Ma
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated Hospital of Zhejiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Zejun Yan
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated Hospital of Zhejiang University, 59, Liuting Street, Ningbo, Zhejiang, China.
| |
Collapse
|
19
|
Technical developments in transurethral resection of bladder tumours. Contemp Oncol (Pozn) 2019; 23:195-201. [PMID: 31992950 PMCID: PMC6978765 DOI: 10.5114/wo.2019.91530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/04/2019] [Indexed: 11/26/2022] Open
Abstract
Bladder cancer is one of the most common malignancies worldwide. The transurethral resection of bladder tumour (TURB) remains the gold standard in both diagnostics and treatment. Because of the importance of TURB in bladder cancer management and the fact that TURB is one of the most commonly performed urologic procedures, it is the subject of continuous technological development. The latest advances in the field of endourology are aimed at increasing surgical accuracy and thus reducing the risk of bladder tumour recurrence and progression. However, despite the constant progress in technology and technique, there are still a lack of good quality data showing the superiority of any of the methods. The aim of this paper is to present available data on new technological developments in surgical technique of TURB. Advantages and disadvantages of currently available methods are discussed, and literature showing their effectiveness and safety is shown.
Collapse
|
20
|
Hayashida Y, Miyata Y, Matsuo T, Ohba K, Sakai H, Taba M, Naito S, Taniguchi K. A pilot study to assess the safety and usefulness of combined transurethral endoscopic mucosal resection and en-bloc resection for non-muscle invasive bladder cancer. BMC Urol 2019; 19:56. [PMID: 31234817 PMCID: PMC6591831 DOI: 10.1186/s12894-019-0486-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Transurethral resection (TUR) is the standard operation used for non-muscle invasive bladder cancer (NMIBC). Although most solid tumors are principally removed via single block resection without incising the mass, disruption of the lesion is unavoidable in traditional TUR. Furthermore, pathological diagnosis is often difficult due to heat-related denaturation of tissues in TUR. Although transurethral en-bloc resection is useful for judging tumor invasion, it is associated with a prolonged operative duration. We attempted to show the safety and usefulness of combined endoscopic mucosal resection (EMR) and en-bloc resection in NMIBC patients. Methods We investigated 39 patients with clinical NMIBC who were treated using our original EMR + en-bloc resection technique, which involved removal of the tumor mass that protruded from the mucosa, using a polypectomy snare similar to that used for EMR. The residual lesion was removed using en-bloc resection. The operative period, duration of hospitalization, and recurrence rates were compared with those of conventional TUR (n = 31). Results The mean (standard deviation, range) time interval for EMR and total operative duration were 1.6 (1.1, 1–5) min and 18.3 (10.5, 3–48) min, respectively. The total operative duration was comparable to that of TUR (17.3 min, p = 0.691). The mean duration of catheterization in the EMR + en-bloc resection group (4.2 days) was also similar to that in the TUR group (3.7 days; p = 0.285). No severe complications were observed with EMR + en-bloc resection. The pathologists were able to determine tumor invasiveness with considerable certainty in all specimens obtained via the EMR + en-bloc procedure than via TUR, and the difference in the ease of diagnosis was statistically significant (p = 0.016). Recurrence rates were comparable (p = 0.662) between the EMR + en-bloc (15.4%) and TUR groups (19.4%). Conclusions Our results demonstrated that the EMR + en-bloc resection technique is feasible, safe, and useful for treating patients with NMIBC. Furthermore, this technique helps provide a more accurate pathological diagnosis.
Collapse
Affiliation(s)
- Yasushi Hayashida
- Department of Urology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
| | - Yasuyoshi Miyata
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Tomohiro Matsuo
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsuru Taba
- Department of Pathology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
| | - Shinji Naito
- Department of Pathology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
| | - Keisuke Taniguchi
- Department of Urology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
| |
Collapse
|
21
|
Li K, Xu Y, Tan M, Xia S, Xu Z, Xu D. 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. Lasers Med Sci 2018; 34:85-92. [PMID: 30171441 DOI: 10.1007/s10103-018-2604-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 11/25/2022]
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.
Collapse
Affiliation(s)
- Kewei Li
- Department of Urology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250000, Shandong, China.,Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China.,Department of Urology, Zhucheng People's Hospital, Zhucheng, 262200, Shandong, China
| | - Yongzhi Xu
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Mingyue Tan
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China
| | - Zhonghua Xu
- Department of Urology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Dongliang Xu
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China. .,Department of Urology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Jingan District, Shanghai, 200003, China.
| |
Collapse
|
22
|
|
23
|
Kramer MW, Altieri V, Hurle R, Lusuardi L, Merseburger AS, Rassweiler J, Struck JP, Herrmann TR. Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer. Eur Urol Focus 2017; 3:567-576. [DOI: 10.1016/j.euf.2016.12.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/29/2022]
|
24
|
Comparison of the efficacy and feasibility of laser enucleation of bladder tumor versus transurethral resection of bladder tumor: a meta-analysis. Lasers Med Sci 2017; 32:2005-2012. [DOI: 10.1007/s10103-017-2308-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/08/2017] [Indexed: 01/03/2023]
|
25
|
Cheng B, Qiu X, Li H, Yang G. The safety and efficacy of front-firing green-light laser endoscopic en bloc photoselective vapo-enucleation of non-muscle-invasive bladder cancer. Ther Clin Risk Manag 2017; 13:983-988. [PMID: 28860782 PMCID: PMC5565370 DOI: 10.2147/tcrm.s141900] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Laser therapy provides an alternative option for treating non-muscle-invasive bladder cancer (NMIBC). However, the clinical evidence for potassium-titanyl-phosphate (KTP) laser en bloc resection is still limited. Here, we investigated the efficacy and safety of the 120-W front-firing KTP laser for the treatment of NMIBC. METHODS A total of 64 patients with NMIBC treated with either a 120-W front-firing KTP-photoselective vapo-enucleation of the bladder tumor (PVEBT, n=34) or transurethral resection of the bladder tumor (TURBT, n=30) were included. En bloc resection was applied to the patients in PVEBT group. RESULTS There was no significant difference in rinsing time (P=0.292), indwelling catheter (P=0.080), pathologic type, and T stage (P=0.870) between the two groups. Compared with the TURBT group, patients treated with PVEBT had a shorter hospitalization stay (P=0.044), a shorter operation time (P=0.008), and a lower muscle miss rate (P=0.044). PVEBT is superior to TURBT in terms of the rate of 1-year recurrence (P=0.015) and tumor grade progression rate (P=0.019). CONCLUSION The 120-W front-firing KTP laser en bloc enucleation technique is a safe and feasible procedure for treating patients with NMIBC. Further external validation in larger cohorts with a long follow-up period is warranted.
Collapse
Affiliation(s)
- Bo Cheng
- Department of Urology, Southern Medical University affiliated Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, People's Republic of China.,Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Xiaofu Qiu
- Department of Urology, Southern Medical University affiliated Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huanhui Li
- Department of Urology, Southern Medical University affiliated Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Guosheng Yang
- Department of Urology, Southern Medical University affiliated Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, People's Republic of China
| |
Collapse
|
26
|
Laser Ablation for Cancer: Past, Present and Future. J Funct Biomater 2017; 8:jfb8020019. [PMID: 28613248 PMCID: PMC5492000 DOI: 10.3390/jfb8020019] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 12/27/2022] Open
Abstract
Laser ablation (LA) is gaining acceptance for the treatment of tumors as an alternative to surgical resection. This paper reviews the use of lasers for ablative and surgical applications. Also reviewed are solutions aimed at improving LA outcomes: hyperthermal treatment planning tools and thermometric techniques during LA, used to guide the surgeon in the choice and adjustment of the optimal laser settings, and the potential use of nanoparticles to allow biologic selectivity of ablative treatments. Promising technical solutions and a better knowledge of laser-tissue interaction should allow LA to be used in a safe and effective manner as a cancer treatment.
Collapse
|
27
|
|
28
|
Wu YP, Lin TT, Chen SH, Xu N, Wei Y, Huang JB, Sun XL, Zheng QS, Xue XY, Li XD. Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor: A meta-analysis. Medicine (Baltimore) 2016; 95:e5372. [PMID: 27828864 PMCID: PMC5106070 DOI: 10.1097/md.0000000000005372] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this meta-analysis was to compare the feasibility of en bloc transurethral resection of bladder tumor (ETURBT) versus conventional transurethral resection of bladder tumor (CTURBT). METHODS Relevant trials were identified in a literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting participant demographics, tumor characteristics, study characteristics, and outcome data were included. RESULTS Seven trials with 886 participants were included, 438 underwent ETURBT and 448 underwent CTURBT. There was no significant difference in operation time between 2 groups (P = 0.38). The hospitalization time (HT) and catheterization time (CT) were shorter in ETURBT group (mean difference[MD] -1.22, 95% confidence interval [CI] -1.63 to -0.80, P < 0.01; MD -0.61, 95% CI -1.11 to -0.11, P < 0.01). There was significant difference in 24-month recurrence rate (24-month RR) (odds ratio [OR] 0.66, 95% CI 0.47-0.92, P = 0.02). The rate of complication with respect to bladder perforation (P = 0.004), bladder irritation (P < 0.01), and obturator nerve reflex (P < 0.01) was lower in ETURBT. The postoperative adjuvant intravesical chemotherapy was evaluated by subgroup analysis, and 24-month RR in CTURBT is higher than that in ETURBT in mitomycin intravesical irrigation group (P = 0.02). CONCLUSION The first meta-analysis indicates that ETURBT might prove to be preferable alternative to CTURBT management of nonmuscle invasive bladder carcinoma. ETURBT is associated with shorter HT and CT, less complication rate, and lower recurrence-free rate. Moreover, it can provide high-qualified specimen for the pathologic diagnosis. Well designed randomized controlled trials are needed to make results comparable.
Collapse
Affiliation(s)
| | | | | | - Ning Xu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Correspondence: Dr Ning Xu, Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian 350005, China (e-mail: )
| | | | | | | | | | | | | |
Collapse
|
29
|
Karl A, Grimm T, Jokisch F, Gaisa NT, Stief CG. Nichtmuskelinvasives Harnblasenkarzinom. Urologe A 2016; 55:1247-58. [DOI: 10.1007/s00120-016-0192-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Chen J, Zhao Y, Wang S, Jin X, Sun P, Zhang L, Wang M. Green-light laser en bloc resection for primary non-muscle-invasive bladder tumor versus transurethral electroresection: A prospective, nonrandomized two-center trial with 36-month follow-up. Lasers Surg Med 2016; 48:859-865. [PMID: 27454755 DOI: 10.1002/lsm.22565] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of LBO laser en bloc resection compared with transurethral electroresection (TURBT) for the treatment of primary non-muscle-invasive bladder tumors. METHODS From September 2010 to February 2012, a prospective, nonrandomized two-center trial was performed. A total of 158 patients (83 underwent laser resection and 75 TURBT) were included in the present study. The preoperative, intraoperative, and postoperative clinical characteristics were recorded and compared in the two groups. RESULTS There were no differences with the preoperative characteristics between the patients in the two groups. The mean operative time was 21.46 ± 10.42 minutes for laser resection and 27.47 ± 15.30 minutes for TURBT (P = 0.004). LBO laser group was also associated with less hemoglobin decrease compared with TURBT group (0.87 ± 0.28 g/ml vs. 1.00 ± 0.33 g/ml, P = 0.009). Obturator nerve reflection was absent during laser resection, whereas was observed in nine patients during TURBT (P = 0.001). Two patients in the TURBT group suffered bladder perforation. Three patients in TURBT group and one patient in LBO laser group experienced urethral stricture. The recurrence-free survival rate did not differ significantly between two groups after 36 months follow-up. CONCLUSIONS The results of our trial have shown that LBO laser en bloc resection is feasible, safe, and effective alternative for the treatment of primary non-muscle-invasive bladder tumors. Besides, it can provide intact specimen for the pathologic diagnosis. Lasers Surg. Med. 48:859-865, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ji Chen
- School of Medicine, Shandong University, Jinan, People's Republic of China.,Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Yong Zhao
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Sijun Wang
- Department of Urology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Xunbo Jin
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Peng Sun
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Longyang Zhang
- Department of Urology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Muwen Wang
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China.
| |
Collapse
|
31
|
“En Bloc” Resection of Nonmuscle Invasive Bladder Cancer: A Prospective Single-center Study. Urology 2016; 90:126-30. [DOI: 10.1016/j.urology.2016.01.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/29/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022]
|
32
|
Can immediate second resection be an alternative to standardized second transurethral resection of bladder tumors? Kaohsiung J Med Sci 2016; 32:147-51. [DOI: 10.1016/j.kjms.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/01/2016] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
|
33
|
Saini AK, Ahuja A, Seth A, Dogra PN, Kumar R, Singh P, Gupta SD. Histomorphological features of resected bladder tumors: Do energy source makes any difference. Urol Ann 2015; 7:466-9. [PMID: 26692666 PMCID: PMC4660697 DOI: 10.4103/0974-7796.157970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Context: The recent advent of bipolar energy in bladder tumor resection has raised many questions regarding density of current and its effect on histopathology of the resected transurethral resection of bladder tumor (TURBT) chips. Aims: The aim of this study is to evaluate the histomorphological features in resected bladder tumors comparing bipolar versus conventional (monopolar) energy. Settings and Design: Inclusion criteria were patients with primary presentation of carcinoma urinary bladder undergoing TURBT. The patients with prior resections were excluded as these could jeopardize the results of cautery artifacts. Materials and Methods: From February 2010 to December 2011, 61 patients with primary carcinoma bladder and meeting our inclusion criteria were compared. Group 1 (n = 31) underwent bipolar-TURBT (B-TURBT) and Group 2 (n = 30) monopolar-TURBT (M-TURBT). Two pathologists, who were blinded to the form of electrocautery used, examined the resected tissue. The degree of cautery artifact in each specimen was recorded. The severity of the cautery artifact was graded as absent, mild, moderate, or severe. The mean age, tumor size, and resection time were recorded in both groups. Statistical Analysis Used: Data were analyzed using SPSS 16. Data were compared in between groups using paired t-test and Pearson's Chi-square test. The significance level was set at 0.05. Results: The mean age, tumor size, and resection time were similar in between the two groups. The pathologists had no obscurity in reaching a correct diagnosis in all cases. The cautery artifacts were graded as absent in 10 (32.2%) and 8 (26.67%), mild in 12 (38.7%) and 11 (36.67%), moderate in 5 (16.1%) and 7 (23.33%) and severe in 4 (12.9%) and 5 (16.66%) cases, respectively in Group 1 and 2. There was no statistically significant histomorphogical dissimilarity between specimens according to the type of cautery used. Conclusions: Bladder tissue obtained from B-TURBT is of equivalent histomorphological feature as that of standard M-TURBT.
Collapse
Affiliation(s)
- Ashish Kumar Saini
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Prem Nath Dogra
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
34
|
Migliari R, Buffardi A, Ghabin H. Thulium Laser Endoscopic En Bloc Enucleation of Nonmuscle-Invasive Bladder Cancer. J Endourol 2015; 29:1258-62. [DOI: 10.1089/end.2015.0336] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Roberto Migliari
- Division of Urology, A.O. Ordine Mauriziano “Umberto I” Hospital, Turin, Italy
| | - Andrea Buffardi
- Division of Urology, A.O. Ordine Mauriziano “Umberto I” Hospital, Turin, Italy
| | - Hassan Ghabin
- Division of Urology, A.O. Ordine Mauriziano “Umberto I” Hospital, Turin, Italy
| |
Collapse
|
35
|
Zhang XR, Feng C, Zhu WD, Si JM, Gu BJ, Guo H, Song LJ, Li C. Two Micrometer Continuous-Wave Thulium Laser Treating Primary Non-Muscle-Invasive Bladder Cancer: Is It Feasible? A Randomized Prospective Study. Photomed Laser Surg 2015; 33:517-23. [PMID: 26397029 DOI: 10.1089/pho.2015.3913] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xin-Ru Zhang
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Chao Feng
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Wei-Dong Zhu
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Jie-Min Si
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Bao-Jun Gu
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Hui Guo
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Lu-Jie Song
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Chao Li
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| |
Collapse
|
36
|
Gershman B, Boorjian SA, Hautmann RE. Management of T1 Urothelial Carcinoma of the Bladder: What Do We Know and What Do We Need To Know? Bladder Cancer 2015; 2:1-14. [PMID: 27376120 PMCID: PMC4927848 DOI: 10.3233/blc-150022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
T1 bladder cancer constitutes approximately 25% of incident bladder cancers, and as such carries an important public health impact. Notably, it has a heterogeneous natural history, with large variation in reported oncologic outcomes. Optimal risk-stratification is essential to individualize patient management, targeting those at greatest risk of progression for aggressive therapies such as early cystectomy, while allowing others to safely pursue bladder-preserving approaches including intravesical bacillus Calmette-Guerrin (BCG). Current strategies for diagnosis, risk-stratification, and treatment are imperfect, but emerging technologies and molecular approaches represent exciting opportunities to advance clinical paradigms in management of this disease entity.
Collapse
|
37
|
Kramer MW, Rassweiler JJ, Klein J, Martov A, Baykov N, Lusuardi L, Janetschek G, Hurle R, Wolters M, Abbas M, von Klot CA, Leitenberger A, Riedl M, Nagele U, Merseburger AS, Kuczyk MA, Babjuk M, Herrmann TRW. En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol 2015; 33:1937-43. [DOI: 10.1007/s00345-015-1568-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 04/17/2015] [Indexed: 12/31/2022] Open
|
38
|
Xu Y, Guan W, Chen W, Xie C, Ouyang Y, Wu Y, Liu C. Comparing the treatment outcomes of potassium-titanyl-phosphate laser vaporization and transurethral electroresection for primary nonmuscle-invasive bladder cancer: A prospective, randomized study. Lasers Surg Med 2015; 47:306-11. [PMID: 25864416 DOI: 10.1002/lsm.22342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Yansheng Xu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Weimin Guan
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Weihao Chen
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Changliang Xie
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Yun Ouyang
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Yiguang Wu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Cuilong Liu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| |
Collapse
|
39
|
Safety and efficacy of transurethral laser therapy for bladder cancer: a systematic review and meta-analysis. World J Surg Oncol 2014; 12:301. [PMID: 25256383 PMCID: PMC4190332 DOI: 10.1186/1477-7819-12-301] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/08/2014] [Indexed: 02/05/2023] Open
Abstract
Background Transurethral laser therapy techniques are increasingly being used in the management of bladder tumors. It has reportedly been associated with good outcomes in small case series. The objective of the present study was to review the published literature and compare transurethral laser therapy for non–muscle-invasive bladder cancer (NMIBC) and conventional transurethral resection of bladder tumor (TURBT). Methods We performed a systematic review and meta-analysis based on randomized controlled trials (RCTs) and controlled clinical trials (CCTs) to assess the two techniques. The eligible RCTs and CCTs were identified in the following electronic databases: PubMed, the Cochrane Central Register of Controlled Trials and Embase. Results Seven studies were included in this systematic review. The baseline characteristics of these studies are comparable. We found no statistical difference between the two techniques regarding operative time. The intra- and postoperative complications showed that the laser procedure was better than TURBT for NMIBC, including obturator nerve reflex, bladder perforation, bladder irrigation rate, duration of catheterization and length of hospital stay. In addition, the 2-year recurrence-free survival improved in the laser group than in the TURBT group. Conclusions Our systematic review and meta-analysis suggests that laser techniques are feasible, safe, effective procedures that provide an alternative treatment for patients with NMIBC. Given that some limitations cannot be overcome, well-designed RCTs are needed to confirm our findings.
Collapse
|
40
|
Bach T, Muschter R, Herrmann TR, Knoll T, Scoffone CM, Laguna MP, Skolarikos A, Rischmann P, Janetschek G, De la Rosette JJ, Nagele U, Malavaud B, Breda A, Palou J, Bachmann A, Frede T, Geavlete P, Liatsikos E, Jichlinski P, Schwaibold HE, Chlosta P, Martov AG, Lapini A, Schmidbauer J, Djavan B, Stenzl A, Brausi M, Rassweiler JJ. Technical solutions to improve the management of non-muscle-invasive transitional cell carcinoma: summary of a European Association of Urology Section for Uro-Technology (ESUT) and Section for Uro-Oncology (ESOU) expert meeting and current and future pers. BJU Int 2014; 115:14-23. [DOI: 10.1111/bju.12664] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thorsten Bach
- Department of Urology; Asklepios Hospital Harburg; Hamburg Germany
| | - Rolf Muschter
- Department of Urology; Diakoniekrankenhaus Rotenburg; Rotenburg Germany
| | | | - Thomas Knoll
- Department of Urology; Klinikum Sindelfingen-Böblingen; Sindelfingen Germany
| | | | - M. Pilar Laguna
- Department of Urology; AMC University of Amsterdam; Amsterdam The Netherlands
| | - Andreas Skolarikos
- Second Department of Urology; Sismanoglio Hospital, Athens Medical School; Athens Greece
| | - Pascal Rischmann
- Department of Urology; Rangueil University Hospital; Toulouse France
| | - Günter Janetschek
- Department of Urology; Paracelsius Medical University; Salzburg Austria
| | | | - Udo Nagele
- Department of Urology; LKH Hall; Hall in Tirol Austria
| | - Bernard Malavaud
- Department of Urology; Rangueil University Hospital; Toulouse France
| | - Alberto Breda
- Department of Urology; Fundacio Puigvert; Autonoma University of Barcelona; Barcelona Spain
| | - Juan Palou
- Department of Urology; Fundacio Puigvert; Autonoma University of Barcelona; Barcelona Spain
| | | | - Thomas Frede
- Department of Urology; Helios Klinik Müllheim; Müllheim Germany
| | - Petrisor Geavlete
- Department of Urology; Saint John Emergency Clinical Hospital; Bucharest Romania
| | | | | | | | - Piotr Chlosta
- Department of Urology; Centre of Oncology; Kielce Poland
| | - Alexey G. Martov
- Department of Endourology; Municipal Clinical Hospital #57 of Moscow; Moscow Russian Federation
| | - Alberto Lapini
- Department of Urology; Careggi Hospital, University of Florence; Florence Italy
| | | | - Bob Djavan
- Department of Urology; Medical University of Vienna; Vienna Austria
| | - Arnulf Stenzl
- Department of Urology; University of Tübingen; Tübingen Germany
| | - Mauricio Brausi
- Department of Urology; New Estense S. Agostino Hospital Ausl Modena; Modena Italy
| | | |
Collapse
|
41
|
Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, Merseburger AS, Herrmann TRW. Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014. World J Urol 2014; 33:571-9. [PMID: 24935098 DOI: 10.1007/s00345-014-1337-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/30/2014] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Bladder cancer (BC) represents a growing health care problem worldwide. In times of tight budgets and an aging society, new strategies for the transurethral treatment of BC are needed. Laser devices used for tumor vaporization and/or en bloc resection provide an alternative to parvenu strategies. MATERIALS AND METHODS Medline/Cochrane search was performed using following terms: bladder cancer, urothelial carcinoma, laser, en bloc, vaporization, photoablation, holmium, thulium, Ho:YAG, Tm:YAG, HoLRBT and TmLRBT. Last date of search was February 12, 2014. RESULTS Eighteen publications in English were identified including 800 patients (Ho:YAG = 652 patients and Tm:YAG = 148 patients). Data on en bloc resection techniques were presented in 10 publications, 7 publications provided data of tumor vaporization and one publication presented data on both. Level of evidence based on SIGN is mainly 3 (non-analytic studies); only three studies are level 2 (prospective case control studies). Tumor vaporization seems to be a promising alternative for the treatment of recurrent tumors in selected patients. It can be performed in an office-based approach without the need of general anesthesia. The use of photodynamic diagnostic might enhance surgical quality. The principle of en bloc resection should provide accurate staging in most cases; however, data on this important aspect are missing. Peri- and postoperative complications are scarce. Due to the nature of the energy source, bladder perforation caused by obturator nerve reflex is highly unlikely when using lasers. There is a trend toward decreased infield recurrence rates. CONCLUSIONS Lasers are potentially useful alternatives to conventional TURBT, but systematical assessments using standardized classification systems and well-designed RCTs are needed to make results comparable.
Collapse
Affiliation(s)
- Mario W Kramer
- Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
42
|
He D, Fan J, Wu K, Wang X, Wu D, Li L, Li X, Liu L, Cao P, Cao J, Chang LS. Novel green-light KTP laser en bloc enucleation for nonmuscle-invasive bladder cancer: technique and initial clinical experience. J Endourol 2014; 28:975-9. [PMID: 24735433 DOI: 10.1089/end.2013.0740] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The standard procedure for staging and treating nonmuscle-invasive bladder cancer (NMIBC) is still transurethral resection of bladder tumor (TURBT) via a wire loop. However, TURBT is associated with serious disadvantages that facilitate tumor recurrence. Recently, lasers have been explored as treatment tools for bladder tumors. Here, we report a novel tumor en bloc enucleation using a front-firing green-light potassium-titanyl-phosphate laser and its initial clinical application. PATIENTS AND METHODS From March through June 2013, 45 patients with NMIBC received modified transurethral resection using a front-firing green-light laser. En bloc enucleation was performed on all tumors. Preoperative and intraoperative data were retrospectively collected. RESULTS All patients successfully went through a session of treatment with front-firing green-light laser enucleation of the bladder tumor. Complications such as bladder hemorrhage, vesicle perforation, and obturator nerve reflex were not encountered during the treatment. The tumor diameter ranges from 0.3 to 3.0 cm with a mean value of 1.8 cm. Mean operative time and enucleation time were 21 (12-38) and 12 (4-23) minutes, respectively. Serum hemoglobin decreased 1.1 (0.1-2.4) mg/dL averagely. Mean catheter time was 2.0 (1.0-3.0) days, and mean postoperative hospital stay was 2.5 (1.5-4.0) days. The stages of bladder cancer included 27 Ta, 15 T1, and 3 T2a. No tumor recurrence was observed at the initial 6-month follow-up. CONCLUSIONS The modified technique using a front-firing green-light laser to en bloc enucleate bladder tumors is effective and safe for treatment of NMIBC. Moreover, it may improve the accurate valuation of tumor stage and prediction of postoperative prognosis, although long-term outcomes and prospective clinical trials are needed.
Collapse
Affiliation(s)
- Dalin He
- 1 Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University , Xi'an, P.R. China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Muto G, Collura D, Giacobbe A, D'Urso L, Muto GL, Demarchi A, Coverlizza S, Castelli E. Thulium:yttrium-aluminum–garnet Laser for En Bloc Resection of Bladder Cancer: Clinical and Histopathologic Advantages. Urology 2014; 83:851-5. [DOI: 10.1016/j.urology.2013.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/29/2013] [Accepted: 12/13/2013] [Indexed: 11/30/2022]
|
44
|
Kramer MW, Abdelkawi IF, Wolters M, Bach T, Gross AJ, Nagele U, Conort P, Merseburger AS, Kuczyk MA, Herrmann TRW. Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer. MINIM INVASIV THER 2014; 23:206-13. [DOI: 10.3109/13645706.2014.880065] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Syed HA, Talbot N, Abbas A, MacDonald D, Jones R, Marr TJ, Rukin NJ. Flexible cystoscopy and Holmium:Yttrium aluminum garnet laser ablation for recurrent nonmuscle invasive bladder carcinoma under local anesthesia. J Endourol 2013; 27:886-91. [PMID: 23537221 DOI: 10.1089/end.2012.0696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The management of recurrent nonmuscle invasive bladder cancer (NMIBC) post-transurethral resection has been based around electrocautery techniques, either under local or general anesthetic. We determine the long-term outcome of the management of NMIBC recurrences treated with Holmium:Yttrium Aluminum Garnet (Ho:YAG) laser ablation under local anesthetic with a flexible cystoscope. PATIENTS AND METHODS We performed a prospective analysis of 151 consecutive patients, undergoing treatment of 444 tumors, between 2006 and 2011 in a University Teaching Hospital. Median follow-up was 24 months (0-58 months). The primary outcome was local, on-site recurrence rates of NMIBC. The secondary outcome measure included off-site recurrence rates, complications, pain perception, and patient satisfaction. RESULTS Local, on-site recurrence rates after first treatment for all NMIBC disease were 10%. In patients with low risk NMIBC (G1/2, Ta), this reduced to around 4% post laser treatment. Higher recurrence rates (14%) were seen in those with high-grade (G3, T1) disease. Treatment was more successful with disease around the trigone, posterior and lateral bladder walls, with a significantly higher risk of recurrence for tumor around the ureteric orifice. The median time to local recurrence was 12 months and off-site recurrence was 25 months. Complication rates were low: dysuria (4.2%), frequency (1.5%), and hematuria (1.9%), with no episodes of bladder perforation. Visual analog pain scores were low, mean score 1 (range 0-7). The overall patient satisfaction was 100%. CONCLUSIONS Flexible cystoscopy and Ho:YAG laser therapy should be considered as a first line treatment option for the management of recurrence in low-grade NMIBC (G1/2, Ta/1) throughout the bladder, except around the ureteric orifices. For those with high-grade disease (G3), the recurrences rates are increased, but the procedure still offers an acceptable recurrence rate. It provides good local disease control, low complications, patient acceptability and tolerance.
Collapse
Affiliation(s)
- Haider A Syed
- Department of Urology, Good Hope Hospital, Sutton Coldfield, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
46
|
O'Neil BB, Lowrance WT. Office-based Bladder Tumor Fulguration and Surveillance: Indications and Techniques. Urol Clin North Am 2013; 40:175-82. [PMID: 23540776 DOI: 10.1016/j.ucl.2013.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article summarizes the current literature on office-based management of low-grade, noninvasive bladder cancer. Discussion includes differences in recurrence and progression rates between neoplasm grades and stages, role of visual grading for diagnosis, cost advantages of treatment outside the operating room, and a step-by-step description of office-based procedures.
Collapse
Affiliation(s)
- Brock B O'Neil
- Division of Urology, University of Utah, Salt Lake City, UT 84132, USA
| | | |
Collapse
|
47
|
Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. [European Association of Urology guidelines on laser technologies]. Actas Urol Esp 2013; 37:63-78. [PMID: 22989380 DOI: 10.1016/j.acuro.2012.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 12/14/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
Collapse
Affiliation(s)
- T R W Herrmann
- Departamento de Urología y Uro-oncología, Medical School of Hanover (MHH), Hanover, Alemania.
| | | | | | | | | |
Collapse
|
48
|
Kim W, Song C, Park S, Kim J, Park J, Kim SC, Cho YM, Hong B, Ahn H. Value of Immediate Second Resection of the Tumor Bed to Improve the Effectiveness of Transurethral Resection of Bladder Tumor. J Endourol 2012; 26:1059-64. [DOI: 10.1089/end.2011.0576] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wansuk Kim
- Department of Urology, Inje University Busan Paik Hospital, Busan, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sejun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jongwon Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Daejeon, Korea
| | - Seong Cheol Kim
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Yong Mee Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
49
|
Kramer MW, Wolters M, Abdelkawi IF, Merseburger AS, Nagele U, Gross A, Bach T, Kuczyk MA, Herrmann TRW. [Transurethral en bloc resection of non-muscle invasive bladder cancer. What is the state of the art?]. Urologe A 2012; 51:798-804. [PMID: 22622487 DOI: 10.1007/s00120-012-2876-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bladder cancer of the urothelium is the second most common malignancy among urological tumors. In view of a worldwide aging population and the fact that increased incidence rates are associated with higher age, new socioeconomic challenges will appear. Even nowadays the treatment of bladder cancer bears the highest lifetime treatment costs per patient among all forms of cancer. In conjunction with higher comorbidity rates among older patients urologists are facing new challenges in the treatment and care of patients with bladder cancer. The standard treatment for non-muscle invasive bladder cancer (NMIBC) is monopolar transurethral resection using resection loops (TURB). Based on experience in the surgical treatment of benign prostatic hyperplasia, different concepts of en bloc resection of bladder tumors using alternative energy resources (e.g. holmium laser, thulium laser and the water-jet HybridKnife) have been developed. Goals of new treatment modalities are reduction of perioperative and postoperative comorbidities, better pathological work-up of the specimens and increased recurrence-free survival. Postulated advantages using laser devices are a more precise cutting line as well as better hemostasis. The evidential value of this review is limited due to the lack of randomized, prospective studies. However, there is a tendency towards a limitation of perioperative and postoperative morbidities as well as higher chance of well-preserved tissues for better pathohistological evaluation using en bloc resection methods. More studies with long-term follow-up periods and better randomization are needed to clarify whether en bloc strategies provide better long-term oncological survival.
Collapse
Affiliation(s)
- M W Kramer
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Hannover
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. EAU guidelines on laser technologies. Eur Urol 2012; 61:783-95. [PMID: 22285403 DOI: 10.1016/j.eururo.2012.01.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
Collapse
Affiliation(s)
- Thomas R W Herrmann
- Department of Urology and Urooncology, Medical School of Hanover [MHH], Hanover, Germany.
| | | | | | | | | | | |
Collapse
|