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Assem A, Kassem A, Sherif M, Lotfi A, Abdelwahed M. Safety, feasibility, and quality of thulium laser en-bloc resection for treatment of non-muscle invasive bladder cancer. Int Urol Nephrol 2023; 55:3103-3109. [PMID: 37639155 PMCID: PMC10611837 DOI: 10.1007/s11255-023-03752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Trans-Urethral Resection of Bladder Tumors (TURBT) is a critical step in diagnosis, staging and treatment of bladder tumors. Conventional TURBT (cTURBT) involves the electro-resection of the tumor into small fragments. This technique leads to concerns about the completeness of resection, under-staging, bleeding, cancer cell implantation, and most importantly, risk of tumour recurrence. To circumvent this, laser en-bloc resection of bladder tumors has been introduced. OBJECTIVES Assessment of the safety, feasibility, and quality of Thulium Laser En-bloc Resection of Tumors (TmL-ERBT) for treatment of Non-Muscle Invasive Bladder Cancer (NMIBC) in various urinary bladder walls as a primary endpoint. The secondary endpoints were to investigate the feasibility of thulium laser use in the re-staging cystoscopy and to evaluate the learning curve of TmL-ERBT. METHODS This is a prospective observational study including all newly diagnosed patients, above 18 years old, with a urinary bladder mass ≤ 4 cm in maximal dimension (measured via bladder ultrasound or CT or MRI). All patients underwent TmL-ERBT under regional anaesthesia in a lithotomy position. All intraoperative complications such as obturator nerve reflex, bladder perforation, and significant bleeding were recorded. Postoperative variables such as the mean catheterization time, bladder irrigation fluid volume and duration, and the mean of hospital stay as well as the postoperative complications were recorded. All patients were risk stratified and managed according to EUA guidelines then followed by a surveillance regimen per 3 months for 6 months. RESULTS The study included 23 patients with a mean age of 53 ± 15.8 years. While 15 patients (65%) had a single tumor, the rest had multiple tumors, ranging from 2 to 3 in number with a total of 36 lesions. No cases required conversion to cTURBT and none of them experienced obturator nerve reflex or bladder perforation. Only one patient (4.3%) had an attack of clot urine retention. The mean hospitalization time was 31.2 ± 14.4 h and the mean catheterization time was 20.4 ± 13.3 h. The Detrusor muscle was present in 20 patients (87%) and the remaining 3 patients required a re-staging cystoscopy which was performed efficiently using thulium laser. None of the treated patients developed tumour recurrence during the follow-up period. In analysis, the duration of complete resection of 2-4 cm tumours was 23-27 min after the 7th case with a resection rate of 0.12-0.15 cm/min. CONCLUSION TmL-ERBT is safe and feasible for complete resection of NMIBC with a short learning curve and adequate cancer control.
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Affiliation(s)
- Ahmed Assem
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Ayman Kassem
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Mohamed Sherif
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Amr Lotfi
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Mohamed Abdelwahed
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt.
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Kronenberg P, Cerrato C, Juliebø-Jones P, Herrmann T, Tokas T, Somani BK. Advances in lasers for the minimally invasive treatment of upper and lower urinary tract conditions: a systematic review. World J Urol 2023; 41:3817-3827. [PMID: 37906263 DOI: 10.1007/s00345-023-04669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE Technological advancements in laser lithotripsy are expanding into numerous fields of urology, like ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and benign and malignant soft-tissue treatments. Since the amount of research regarding lasers in urology has grown exponentially, we present a systematic review of the most recent and relevant advances encompassing all lasers used in urological endoscopic treatment. METHODS We performed a literature search using PubMed (May 2023) to obtain information about lasers for urological purposes. We included only recent data from published articles between 2021 and 2023 or articles ahead of print. RESULTS Lasers are widely used in lithotripsy for ureteric, renal, and bladder stones, benign prostate surgery, and bladder and upper tract tumor ablation. While the holmium (Ho:YAG) laser is still predominant, there seems to be more emphasis on pulse modulation and newer lasers such as thulium fiber laser (TFL) and pulsed Tm:YAG laser. CONCLUSION The use of lasers and related technological innovations have shown increasing versatility, and over time have proven to be invaluable in the management of stone lithotripsy, treatment of benign and malignant prostate diseases, and urothelial tumors. Laser endoscopic treatment is heavily based on technological nuances, and it is essential to know at least the basics of these technologies. Ultimately the choice of laser used depends on its availability, cost, surgeon experience and expertise.
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Affiliation(s)
| | - Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Thomas Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
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Diana P, Gallioli A, Fontana M, Territo A, Bravo A, Piana A, Baboudjian M, Gavrilov P, Rodriguez-Faba Ó, Gaya JM, Algaba F, Palou J, Breda A. Energy source comparison in en-bloc resection of bladder tumors: subanalysis of a single-center prospective randomized study. World J Urol 2023; 41:2591-2597. [PMID: 35639159 PMCID: PMC9152642 DOI: 10.1007/s00345-022-04042-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/02/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Different energy sources are employed to perform en-bloc transurethral resection of bladder tumor (ERBT). No study compared different energy sources in ERBT. The aim is to compare the different ERBT sources in terms of pathological, surgical and postoperative outcomes. METHODS This is a sub-analysis of a prospective randomized trial enrolling patients submitted to ERBT vs conventional TURBT from 03/2018 to 06/2021 (NCT04712201). 180 patients enrolled in ERBT group were randomized 1:1:1 to receive monopolar (m-ERBT), bipolar (b-ERBT) or thulium laser (l-ERBT). Endpoints were the comparison between energies in term of pathological analysis, intra, and post-operative outcomes. RESULTS 49 (35%) m-ERBT, 45 (32.1%) b-ERBT, and 46 (32.9%) l-ERBT were included in final analysis. The rate of detrusor muscle (DM) presence was comparable between the energies used (p = 0.796) or the location of the lesion (p = 0.662). Five (10.2%), 10 (22.2%) and 0 cases of obturator nerve reflex (ONR) were recorded in m-ERBT, b-ERBT and I-ERBT groups, respectively (p = 0.001). Conversion to conventional TURBT was higher for lesions located in the anterior wall/dome/neck (p < 0.001), irrespective from the energy used. The presence of artifact in the pathological specimen was higher for lesions at the posterior wall (p = 0.03) and trigone (p = 0.03). CONCLUSIONS In our study, no difference in staging feasibility among energies was found. Laser energy might be beneficial in lateral wall lesions to avoid ONR. Since there is an increased risk of ERBT conversion to conventional TURBT for lesions of the anterior wall, electrocautery might be preferred over laser to avoid waste of material.
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Affiliation(s)
- Pietro Diana
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
- Department of Urology, Humanitas Research Hospital-IRCCS, Rozzano, Italy.
| | - Andrea Gallioli
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Matteo Fontana
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Angelo Territo
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alejandra Bravo
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Piana
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Michael Baboudjian
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
- Department of Urology, APHM, North Academic Hospital, Marseille, France
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Pavel Gavrilov
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Óscar Rodriguez-Faba
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Josep Maria Gaya
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Ferran Algaba
- Fundació Puigvert, Department of Pathology, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
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Sun JX, An Y, Xu MY, Liu CQ, Xu JZ, Xia QD, Wang SG. Development of a dynamic risk system for predicting the risk of recurrence and progression in patients with non-muscle-invasive bladder cancer after thulium laser resection of bladder tumor or transurethral resection of bladder tumor followed by intravesical BCG instillation. Front Oncol 2023; 13:1133161. [PMID: 37476386 PMCID: PMC10354449 DOI: 10.3389/fonc.2023.1133161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
Background The high recurrence rate of non-muscle-invasive bladder cancer (NMIBC) after tumor resection brings huge physical and financial burdens for patients. Several predictive models that predict the recurrence of patients with NMIBC have drawbacks in clinical practice. With the rapid development of therapeutic methods, more factors should be taken into consideration when constructing predictive model. Methods We retrospectively enrolled 90 patients who were diagnosed as intermediate- or high-risk NMIBC and received a Thulium laser resection of bladder tumor (TmLRBT) or transurethral resection of bladder tumor (TURBT) followed by BCG instillation. Univariate Cox regression analysis and multivariate Cox regression analysis were performed to screen out the independent prognostic factors of recurrence free survival (RFS). A nomogram and risk index were constructed using these prognostic factors. Results In this study, 22 patients suffered recurrence; 37 patients (41%) received TmLRBT, and over 90% patients completed intravesical BCG instillation for one year. The univariate Cox regression showed that surgery (TURBT vs TmLRBT), previous bladder tumor, tumor number, pathological stage, post-operative catheterization and number of BCG therapy were associated with RFS. The multivariate Cox regression revealed that surgery (TURBT vs TmLRBT) (HR = 3.16, 95%CI [1.02 - 9.83]); previous bladder tumor (HR = 4.03, 95%CI [1.41 - 11.54]); number of BCG therapy (HR = 0.89, 95%CI [0.84 - 0.95]) were independent prognostic factors. A nomogram was constructed and exhibited excellent capability in predicting the RFS with an AUC of 0.789, 0.848, 0.806 at 6-, 12- and 24-months respectively and a c-index of 0.822. Also, the calibration curve and decision curve analysis were performed to verify the predictive efficacy. The risk index was derived from the nomogram and also exhibited favorable capability in predicting the progression free survival (PFS) of patients. Conclusions Patients who received TmLRBT, without previous bladder tumor history and had more intravesical BCG instillations are likely to have better RFS. The nomogram and the risk index which were constructed to predict the RFS and PFS of patients may help urologists to make clinical decisions and aid in precision medicine.
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Affiliation(s)
| | | | | | | | | | - Qi-Dong Xia
- *Correspondence: Shao-Gang Wang, ; Qi-Dong Xia,
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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.
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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.
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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.
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Yanagisawa T, Matsukawa A, Iwatani K, Sato S, Hayashida Y, Okada Y, Yorozu T, Fukuokaya W, Sakanaka K, Urabe F, Kimura S, Tsuzuki S, Shimoda M, Takahashi H, Miki J, Shariat SF, Kimura T. En Bloc Resection Versus Conventional TURBT for T1HG Bladder Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol 2023; 30:3820-3828. [PMID: 36897417 DOI: 10.1245/s10434-023-13227-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/23/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND We aimed to assess the clinical, oncological, and pathological impact of en bloc resection of bladder tumors (ERBT) compared with conventional transurethral resection of bladder tumors (cTURBT) for pT1 high-grade (HG) bladder cancer. PATIENTS AND METHODS We retrospectively analyzed the record of 326 patients (cTURBT: n = 216, ERBT: n = 110) diagnosed with pT1 HG bladder cancer at multiple institutions. The cohorts were matched by one-to-one propensity scores based on patient and tumor demographics. Recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and perioperative and pathologic outcomes were compared. The prognosticators of RFS and PFS were analyzed using the Cox proportional hazard model. RESULTS After matching, 202 patients (cTURBT: n = 101, ERBT: n = 101) were retained. There were no differences in perioperative outcomes between the two procedures. The 3-year RFS, PFS, and CSS were not different between the two procedures (p = 0.7, 1, and 0.7, respectively). Among patients who underwent repeat transurethral resection (reTUR), the rate of any residue on reTUR was significantly lower in the ERBT group (cTURBT: 36% versus ERBT: 15%, p = 0.029). Adequate sampling of muscularis propria (83% versus 93%, p = 0.029) and diagnostic rates of pT1a/b substaging (90% versus 100%, p < 0.001) were significantly better in ERBT specimen compared with cTURBT specimen. On multivariable analyses, pT1a/b substaging was a prognosticator of disease progression. CONCLUSIONS In patients with pT1HG bladder cancer, ERBT had similar perioperative and mid-term oncologic outcomes compared with cTURBT. However, ERBT improves the quality of resection and specimen, yielding less residue on reTUR and yielding superior histopathologic information such as substaging.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasushi Hayashida
- Department of Urology, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Yohei Okada
- Department of Urology, Saitama Medical Center, Saitama, Japan
| | - Takashi Yorozu
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Shimoda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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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.
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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
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Tonin E, Shariat SF, Schiavina R, Brunocilla E, D'Andrea D. En-bloc resection of non-muscle invasive bladder cancer: does it really make a difference? Curr Opin Urol 2023; 33:147-151. [PMID: 36710595 DOI: 10.1097/mou.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Transurethral resection of bladder tumour (TURBT) followed by pathology investigation of the obtained specimens is the initial step in the management of urinary bladder cancer (UBC). By following the basic principles of oncological surgery, en-bloc resection of bladder tumour (ERBT) aims to overcome the limitations associated with conventional transurethral resection, and to improve the quality of pathological specimens for a better decision making. The current bulk of evidence provides controversial results regarding the superiority of one technique over the other. The aim of this article is to summarize the recent data and provide evidence on this unanswered question. RECENT FINDINGS Despite heterogeneous and controversial data, ERBT seems to have a better safety profile and deliver higher quality pathologic specimens. However, the recent evidence failed to support the hypothesized oncological potential benefits of ERBT in the initial surgical treatment of patients with UBC. SUMMARY ERBT has gained increasing interest globally in the past decade. It continues to represent a promising strategy with a variety of features intended to solve the inherent limitations of TURBT. However, the current quality of evidence does not allow solid conclusions to be drawn about its presumed superiority compared with the conventional technique.
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Affiliation(s)
- Elena Tonin
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Leonardi R, Vecco F, Iacona G, Calarco A, Mantica G. TULA DUAL: Trans Urethral Laser Ablation of recurrent bladder tumors in outpatient setting. Arch Ital Urol Androl 2023; 95:11171. [PMID: 36924368 DOI: 10.4081/aiua.2023.11171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
To the Editor, Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after prostate adenocarcinoma. Usually occurs in patients between 60 and 70 years old, three times more frequently in men than women. About 75% of bladder cancer are pTa or pT1, even more frequently considering a population younger than 40 years old. Early detection is of paramount importance since allows to find tumors when they are still superficial and therefore with a better prognosis.
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Affiliation(s)
| | - Francesco Vecco
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
| | | | | | - Guglielmo Mantica
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
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11
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Lu Y, Jiang S, Yin X, Guo J, Zhu X, Ma H, Zhang G, Yu H, Xiao Y, Yang Y. Long-term effect of transurethral partial cystectomy with a 2-micrometer continuous-wave laser for non-muscle-invasive bladder cancer. Front Surg 2023; 10:1117997. [PMID: 37139195 PMCID: PMC10149721 DOI: 10.3389/fsurg.2023.1117997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/27/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose We have reported the efficacy and safety of 2-micrometer continuous-wave laser cystectomy of non-muscle invasive bladder tumor (NMIBC) (J Urol. 2009;182:66-9). In this study, we evaluated the long-term outcomes of patients with NMIBC who underwent transurethral partial cystectomy with a 2-micrometer continuous-wave laser, and explored the risk factors for tumor recurrence. Methods This was a retrospective study of patients with NMIBC planned to undergo transurethral partial cystectomy with a 2-micrometer continuous-wave laser at the Fourth Medical Center of the PLA General Hospital between January 2012 and December 2014. The primary outcome was bladder cancer recurrence. Results A total of 75 patients were enrolled. Sixty-two (82.7%) were male. The patients were 59.8 ± 12.9 years of age. The mean operation time was 38.7 ± 20.4 min. No Clavien grade >2 complications occurred. The duration of catheter indwelling was 3.6 ± 1.8 days. The hospital stay was 6.0 ± 2.3 days. The median follow-up was 80 months. A total of 17 patients had a recurrence during follow-up, and the recurrence-free survival (RFS) rate was 77.3%. In the multivariable analysis, the tumor risk group were independently associated with the recurrence of NMIBC (p = 0.026). Conclusions After TURBT with a 2-micrometer continuous-wave laser, RFS was 77.3% at the median follow-up of 80 months. All complications were mild. Only tumor risk group was independently associated with the recurrence of NMIBC.
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Affiliation(s)
- Yongliang Lu
- Senior Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Sinan Jiang
- Department of Urology, The Fourth Medical Centre of PLA General Hospital, Beijing, China
| | - Xiaotao Yin
- Senior Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Jiaxiang Guo
- Department of Urology, The Fourth Medical Centre of PLA General Hospital, Beijing, China
| | - Xiaoying Zhu
- Senior Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Han Ma
- Senior Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Guohui Zhang
- Senior Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
- Correspondence: Guohui Zhang Hualiang Yu Yi Xiao
| | - Hualiang Yu
- Department of Urology, The Fourth Medical Centre of PLA General Hospital, Beijing, China
- Correspondence: Guohui Zhang Hualiang Yu Yi Xiao
| | - Yi Xiao
- Senior Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
- Correspondence: Guohui Zhang Hualiang Yu Yi Xiao
| | - Yong Yang
- Department of Urology, The Fourth Medical Centre of PLA General Hospital, Beijing, China
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12
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Gu J, He Z, Chen Z, Wu H, Ding M. Efficacy and safety of 2-micron laser versus conventional trans-urethral resection of bladder tumor for non-muscle-invasive bladder tumor: A systematic review and meta-analysis. J Cancer Res Ther 2022; 18:1894-1902. [PMID: 36647947 DOI: 10.4103/jcrt.jcrt_608_22] [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: 01/13/2023]
Abstract
Aim To compare the clinical efficacy and safety of 2-micron laser and conventional trans-urethral resection of bladder tumor (TURBT) in the treatment of non-muscle-invasive bladder tumor (NMIBT), providing evidence-based evidence for clinical treatment. Materials and Methods PubMed, Embase, Cochrane Library, CMB, CNKI, and WanFang databases were searched since their inception until December 2021 for all eligible randomized controlled trials (RCTs) related to 2-micron laser and TURBT for treating NMIBT. Two researchers independently screened the literature, extracted outcome indicators, and assessed the risk of bias according to the inclusion and exclusion criteria. Binary and continuous variables were calculated by relative risk (RR) and mean difference (MD) with 95% confidence interval (95%CI), respectively. RevMan 5.4 and Stata 15.0 software were used for all statistical analysis. Results A total of ten RCTs involving 1,163 patients were included: 596 cases in the 2-micron laser group and 567 cases in the TURBT group. The results of the meta-analysis revealed that 2-micron laser has advantages over the TURBT in operative duration (MD = -2.94, 95% confidence interval (CI) [-8.55, 2.68], P = 0.31), operative blood loss (MD = -19.93, 95%CI [-33.26, -6.60], P = 0.003), length of hospital stay (MD = -0.94, 95%CI [-1.38, -0.50], P < 0.001), post-operative bladder irrigation time (MD = -28.60, 95%CI [-50.60, -6.59], P = 0.01), period of catheterization days (MD = -1.07, 95%CI [-1.73, -0.40], P = 0.002), obturator nerve reflex (RR = -0.06, 95%CI [0.02, 0.15], P < 0.001), bladder perforation (RR = 0.14, 95%CI [0.06, 0.35], P < 0.001), and bladder irritation (RR = 0.30, 95%CI [0.20, 0.46], P < 0.001). There was no significant difference between the two surgical methods in post-operative urethral stricture and short-term recurrence of NMIBT. Conclusion Compared with TURBT, 2-micron laser may be safer and more effective for NMIBT management. However, these conclusions need to be validated through more high-quality RCTs because of the quality limitations and publication bias of the included studies.
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Affiliation(s)
- Jun Gu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, China
| | - Zexi He
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, China
| | - Zhenjie Chen
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, China
| | - Haichao Wu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, China
| | - Mingxia Ding
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, China
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13
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Marcq G, Vernooij RWM, Alvez GA, Escobar Liquitay CM, Dahm P. En bloc versus standard transurethral resection of bladder tumors for non‐muscle‐invasive bladder cancer patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022; 2022:CD015105. [PMCID: PMC9633077 DOI: 10.1002/14651858.cd015105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of en bloc resection compared with conventional transurethral resection of the bladder tumor (conventional TURBT) in patients with non‐muscle‐invasive bladder cancer.
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Affiliation(s)
| | - Gautier Marcq
- Urology DepartmentClaude Huriez Hospital, CHU LilleLilleFrance,UMR9020-U1277 – CANTHER - Cancer Heterogeneity Plasticity and Resistance to TherapiesUniversité de Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de LilleLilleFrance
| | - Robin WM Vernooij
- Department of Nephrology and Hypertension and Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtNetherlands
| | - Gustavo Ariel Alvez
- Cochrane Center Instituto Universitario Hospital Italiano de Buenos AiresInstituto Universitario Hospital Italiano de Buenos AiresCiudad Autónoma de Buenos AiresArgentina
| | | | - Philipp Dahm
- Urology SectionMinneapolis VA Health Care SystemMinneapolisMinnesotaUSA
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14
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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]
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15
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Systematic review and meta-analysis of randomized controlled trials of perioperative outcomes and prognosis of transurethral en-bloc resection vs. conventional transurethral resection for non-muscle-invasive bladder cancer. Int J Surg 2022; 104:106777. [PMID: 35850465 DOI: 10.1016/j.ijsu.2022.106777] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This article aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of perioperative outcomes and prognosis of transurethral en-bloc resection versus conventional transurethral resection for non-muscle-invasive bladder cancer (NMIBC). METHODS We searched MEDLINE, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) to find eligible RCTs. The studies were classified by version 2 of the Cochrane risk-of-bias tool for randomized trials. Review Manager 5.4.0 was used to evaluate the data. The certainty of the evidence was assessed using the Guideline Development Tool by GRADEpro GDT. RESULTS Seven RCTs with 1142 patients was included in the present study. The results indicated that bladder perforation (OR = 0.17; 95% CI 0.05 to 0.67; P = 0.01), obturator nerve reflex (OR = 0.03; 95% CI 0.01 to 0.13; P < 0.00001), residual tumor (OR = 0.24; 95% CI 0.08 to 0.77; P = 0.02) and repeat transurethral resection of bladder tumor (re-TURBT) (OR = 0.54; 95% CI 0.34 to 0.85; P = 0.008) were significantly reduced in the en-bloc resection group than the conventional resection group. However, there were no significant differences in hemoglobin deficit (p = 0.31), urethral stricture (p = 0.47), and detrusor muscle presence (P = 0.16) between both groups. Besides, resection time (p = 0.25), operative time (p = 0.20), catheter dwell time (p = 0.24), and length of hospital stay (p = 0.16) were similar in the two groups. Meanwhile, en-bloc resection yielded no advantage for the 3-month (P = 0.11), 6-month (P = 0.05), 1-year (P = 0.61), 2-year (P = 0.53), and 3-year (P = 0.26) tumor recurrence rates. CONCLUSIONS Our meta-analysis shows that transurethral en-bloc resection is associated with comparable outcomes to conventional transurethral resection for recurrence-free survival in NMIBC patients. En-bloc resection is more feasible and safer than conventional resection for NMIBC, with fewer intraoperative complications, less residual tumor, and less re-TURBT.
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16
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Severgina LO, Kislyakov DA, Korovin IA, Sorokin NI. [Interpretation of biopsy material after transuretral and laser en bloc resection of non-muscle-invasive bladder cancer]. Arkh Patol 2022; 84:32-39. [PMID: 35639841 DOI: 10.17116/patol20228403132] [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: 11/17/2022]
Abstract
Bladder cancer is one of the most common onco-urological diseases, ranked second in frequency among all tumors of the urinary system after prostate cancer. At the time of detection of the primary tumor, approximately 75% of patients have no invasion into the muscularis layer (non-muscle-invasive carcinoma), with tumor growth limited to the basal membrane (stage Ta) or submucosal base (stage T1). Removal of the tumor in a «unified block» (laser en-bloc resection or L-ERBT), unlike routine transurethral resection, allows to obtain qualitative biopsy material for precise pathomorphological staging of the tumor process. In order to accurately stratify a patient into one or another risk group, verification of the following morphological parameters is required: degree of tumor differentiation and its malignancy, depth of invasion, foci of carcinoma in situ at resection margins, presence or absence of lymphovascular invasion. Identification of tumor variant histology is also recommended. Information on presence or absence of detrusor elements in the specimen is necessary in the morphological report, as this parameter is considered as a criterion of radically performed tumor removal. According to ICCR recommendations (International Collaboration on cancer reporting), it is recommended to use subclassification of T1 stage using all possible criteria: volume and/or depth of invasion (assessed in mm), and/or width of invasion «spot» (assessed in mm), and/or involvement of anatomical structure - muscularis mucosae. Full morphological examination of the material obtained during the primary resection of the tumor is an important step in the diagnosis and treatment of bladder cancer, as it allows to stratify the patient into one or another risk group and, accordingly, allows to develop a personalized postoperative management.
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Affiliation(s)
- L O Severgina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D A Kislyakov
- Voskresensk district hospital No. 2, Voskresensk, Russia
| | - I A Korovin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N I Sorokin
- Lomonosov Moscow State University, Moscow, Russia
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17
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Gallioli A, Diana P, Fontana M, Territo A, Rodriguez-Faba Ó, Gaya JM, Sanguedolce F, Huguet J, Mercade A, Piana A, Aumatell J, Bravo-Balado A, Algaba F, Palou J, Breda A. En Bloc Versus Conventional Transurethral Resection of Bladder Tumors: A Single-center Prospective Randomized Noninferiority Trial. Eur Urol Oncol 2022; 5:440-448. [PMID: 35618567 DOI: 10.1016/j.euo.2022.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/02/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND It has been proposed that en bloc resection of bladder tumor (ERBT) improves the quality of tumor resection. A recent international collaborative consensus statement on ERBT underlined the lack of high-quality prospective studies precluding the achievement of solid conclusion on ERBT. OBJECTIVE To compare conventional transurethral resection of bladder tumor (cTURBT) and ERBT. DESIGN, SETTING, AND PARTICIPANTS This study (NCT04712201) was a prospective, randomized, noninferiority trial enrolling patients diagnosed with bladder cancer (BC) undergoing endoscopic intervention. Inclusion criteria were: tumor size ≤3 cm, three or fewer lesions, and no sign of muscle invasion and/or ureteral involvement. For a noninferiority rate in BC staging of 5% (α risk 2.5%; β risk 20%), a total of 300 subjects were randomized to ERBT treatment at a 1:1.5 allocation ratio. INTERVENTION TURBT and ERBT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the presence of detrusor muscle at final histology. Secondary outcomes include BC staging, T1 substaging, artifacts, complications, the rate of adjuvant treatment, and oncological outcomes. RESULTS AND LIMITATIONS From April 2018 to June 2021, 300 patients met the inclusion criteria. Of these, 248 (83%) underwent the assigned intervention: 108 patients (44%) underwent cTURBT and 140 (57%) underwent ERBT. The rate of detrusor muscle presence for ERBT was noninferior to that for TURBT (94% vs 95%; p = 0.8). T1 substaging was feasible in 80% of cTURBT cases versus 100% of ERBT cases (p = 0.02). Complication rates, rates of postoperative adjuvant treatment, catheterization time, and hospital stay were comparable between the two groups (p > 0.05). The recurrence rate at median follow-up of 15 mo (interquartile range 7-28) was 18% for cTURBT versus 13% for ERBT (p = 0.16). Limitations include the single high-volume institution and the short-term follow-up. CONCLUSIONS Our study has the highest level of evidence for comparison of ERBT versus TURBT. ERBT was noninferior to TURBT for BC staging. The rate of T1 substaging feasibility was significantly higher with ERBT. PATIENT SUMMARY We compared two techniques for removing tumors from the bladder. The en bloc technique removes the tumor in one piece and is not inferior to the conventional method in terms of the quality of the surgical resection and cancer staging assessment.
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Affiliation(s)
- Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain; Department of Urology, Humanitas Research Hospital IRCCS, Rozzano, Italy.
| | - Matteo Fontana
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Óscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Huguet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Asier Mercade
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Piana
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Julia Aumatell
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Ferran Algaba
- Department of Pathology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
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18
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Tontini GE, Dioscoridi L, Rimondi A, Cantù P, Cavallaro F, Giannetti A, Elli L, Pastorelli L, Pugliese F, Mutignani M, Vecchi M. [Not Available]. Endosc Int Open 2022; 10:E386-E393. [PMID: 35528218 PMCID: PMC9068277 DOI: 10.1055/a-1781-7066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/21/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives and study aims
Recent pilot studies have assessed the feasibility of a novel 1.9-/1.5-μm dual emission endoscopic laser treatment (
1.9-/1.5-μm
DEELT) for endoscopic hemostasis, ablation and resection. In this study, we investigated the safety and efficacy of
1.9-/1.5-μm
DEELT in patients with chronic anemia due to gastrointestinal vascular lesions in a real-life multicenter cohort setting.
Patients and methods
Consecutive patients with moderate/severe iron-deficiency anemia undergoing
1.9-/1.5-μm
DEELT for upper and lower gastrointestinal bleeding due to vascular lesions were enrolled in three academic referral centers. Safety and successful ablation of vascular lesions were the primary outcomes. Long-term hemoglobin level, blood transfusion requirements, endoscopic severity scores of complex vascular disorders and technical lasing parameters were also assessed. Long-term hemoglobin variations have been further assessed, with repeated measure analysis of variance and univariate analyses.
Results
Fifty patients (median age 74; range 47 to 91 years) with gastric antral vascular ectasia (GAVE) (22), angioectasia (22) and radiation proctopathy (6) underwent 58
1.9-/1.5-μm
DEELT between 2016 and 2020. All procedures were technically feasible leading to successful ablation of the targeted lesion/s, with no incident or adverse event potentially related to the
1.9-/1.5-μm
DEELT technique. Within a 6-month follow-up, hemoglobin values significantly rose (+ 1.77 at 1 month and + 1.70 g/dL at 6 months,
P
< 0.01), the blood supply requirement decreased (at least one transfusion in 32 versus 13 patients,
P
< 0.01), and GAVE lesions showed a clear endoscopic improvement (from 5 points to 1 points,
P
< 0.01).
Conclusions
The 1.9-/1.5-μm laser system is a safe and effective endoscopic tool for haemostatic ablation of bleeding vascular lesions within the gastrointestinal tract in tertiary referral centers.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Alessandro Rimondi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Postgraduate Specialization in Gastrointestinal Diseases, University of Milan, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy,Gastroenterology and Endoscopy Unit, IRCCS Multimedica, Sesto San Giovanni, Milano
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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19
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Yu J, Zheng J. Comparative efficacy and safety of transurethral laser surgery with holmium laser, KTP laser, 2-micron laser or thulium laser for the treatment of non-muscle invasive bladder carcinoma: a protocol of network meta-analysis. BMJ Open 2021; 11:e055840. [PMID: 34907074 PMCID: PMC8671993 DOI: 10.1136/bmjopen-2021-055840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The potential of transurethral laser surgery in treating non-muscle invasive bladder cancer (NMIBC) has been confirmed, however which types of lasers may be preferentially prescribed remains a debate. The aim of this network meta-analysis is to investigate the comparative efficacy and safety of transurethral laser surgery with four common types of laser including holmium laser, potassium titanylphosphate (KTP) laser, 2-micron laser or thulium laser for the treatment of NMIBC. METHODS AND ANALYSIS A systematic search will be conducted to search all potentially eligible randomised controlled trials comparing different transurethral laser surgeries with each other or with standard transurethral resection among patients with NMIBC in PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure, Wanfang database and Chongqing VIP from their inception until 31 May 2021. Two reviewers will be asked to independently select eligible studies, and assess the risk of bias of individual study with Cochrane risk of bias assessment tool. A random-effects network meta-analysis based on Markov chain Monte Carlo method will be carried out. Ranking probabilities will be considered to rank all laser types. Quantitative analysis will be carried out by using WinBUGS V.1.4.3. ETHICS AND DISSEMINATION Ethical approval is not required because this is a network meta-analysis of published data. We will submit all findings to some conferences for preliminary communication and to a peer-reviewed journal for publication. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/TD9MW.
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Affiliation(s)
- Jinfeng Yu
- Department of Urology Surgery, The First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Junbiao Zheng
- Department of Urology Surgery, The First People's Hospital of Jiashan, Jiashan, Zhejiang, China
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20
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Liu Z, Long G, Zhang Y, Sun G, Ouyang W, Wang S, Xu H, Wang Z, Guan W, Yu X, Hu Z, Chen Z, Wang S, Li H. Thulium Laser Resection of Bladder Tumors vs. Conventional Transurethral Resection of Bladder Tumors for Intermediate and High Risk Non-Muscle-Invasive Bladder Cancer Followed by Intravesical BCG Immunotherapy. Front Surg 2021; 8:759487. [PMID: 34820417 PMCID: PMC8606824 DOI: 10.3389/fsurg.2021.759487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Thulium laser resection of bladder tumors (TmLRBT) is recently considered as a common treatment option for non-muscle-invasive bladder cancers (NMIBC), but whether it is superior to Transurethral resection of bladder tumors (TURBT) are still undetermined. Materials and Methods: We retrospectively screened our institution database to identify patients who were treated by conventional TURBT or TmLRBT for NMIBC and followed by intravesical bacillus Calmette-Guérin (BCG) immunotherapy. The preoperative characteristics, perioperative outcomes, and recurrence-free survival were compared to assess the safety and efficacy of the two procedures. Results: Eventually, 90 patients who underwent TmLRBT (n = 37) or TURBT (n = 53) followed by intravesical BCG immunotherapy were included. Two groups were similar in baseline characteristics except for the smaller tumor size of the TmLRBT group(1.7 cm vs. 2.2 cm; P = 0.036). Obturator nerve reflex occurred in eight patients in the TURBT group and 3 of them suffered from bladder perforation while none happened in the TmLRBT group. The TmLRBT also had a shorter irrigation duration. In the multivariate Cox regression, the TmLRBT was related to less recurrence risk (HR: 0.268; 95% CI, 0.095–0.759; P = 0.013). Conclusion: Our results suggested that TmLRBT is safer than conventional TURBT with fewer perioperative complications, and it offers better cancer control, therefore might be a superior option for NMIBC patients with intermediate and high recurrence risk.
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Affiliation(s)
- Zheng Liu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Geriatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Chen
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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21
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Li L, Na R, Mi T, Cheng H, Ma L, Chen G. Medical Image Diagnostic Value of Computed Tomography for Bladder Tumors. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:3781028. [PMID: 34824598 PMCID: PMC8610659 DOI: 10.1155/2021/3781028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study computed tomography (CT) imaging characteristics of bladder tumors, to explore the value of CT in tumor diagnosis, and to identify the relevant factors of CT missed diagnosis so that medical staff can be more accurate in the diagnosis of bladder tumors. METHODS To retrospectively analyze the CT manifestations of 153 bladder tumor cases confirmed by paraffin pathology in our hospital and to study the difference between the benign and CT imaging features. CT indicators mainly include the number, location, morphology, calcification, bladder wall smoothness, CT value, degree of enhancement, and invasion of surrounding tissues and organs. Then, we retrospectively analyze 17 cases of CT missed diagnosis of bladder tumors, analyze related factors, and discuss the role of CT in the diagnosis of bladder tumors. RESULTS This study has shown that with the help of CT images, the diagnosis rate of bladder tumors has been greatly improved. Of the 153 patients studied, noninvasive urothelial carcinoma accounted for 18.95% of all benign and malignant bladder tumors, invasive urothelial carcinoma accounted for 67.93%, prostatic metastatic carcinoma and inflammatory myofibroblastoma accounted for 8.47%, pheochromocytoma accounted for 1.31%, inverted papilloma accounted for 1.31%, tubular choriocarcinoma accounted for 0.63%, and endocystitis accounted for 1.31%. In addition, the blood supply level, CT index bladder wall smoothness, and CT value are also statistically significant (P < 0.05). CONCLUSIONS CT is of high value in the diagnosis of bladder tumors, and benign and malignant bladder tumors have CT and CT imaging features. The size of bladder tumors is related to the missed diagnosis rate of CT. The application of CT examination technology can improve the accuracy of diagnosis of bladder tumors.
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Affiliation(s)
- Lin Li
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Risu Na
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Tao Mi
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Hao Cheng
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Lili Ma
- Qinghai University, Xining, Qinghai 810000, China
| | - Guojun Chen
- Department of Urology, Affiliated Hospital of Qinghai University, Xining, Qinghai 810000, China
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22
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Sari Motlagh R, Rajwa P, Mori K, Laukhtina E, Aydh A, Katayama S, Yanagisawa T, König F, Grossmann NC, Pradere B, Mostafai H, Quhal F, Karakiewicz PI, Babjuk M, Shariat SF. Comparison of Clinicopathologic and Oncological Outcomes Between Transurethral En Bloc Resection and Conventional Transurethral Resection of Bladder Tumor: A Systematic Review, Meta-Analysis and Network Meta-Analysis with Focus on Different Energy Sources. J Endourol 2021; 36:535-547. [PMID: 34693740 DOI: 10.1089/end.2021.0688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: It has been hypothesized that transurethral en bloc (TUEB) of bladder tumor offers benefits over conventional transurethral resection of bladder tumor (cTURBT). This study aimed to compare disease outcomes of TUEB and cTURBT with focus on the different energy sources. Methods: A systematic search was performed using PubMed and Web of Science databases in June 2021. Studies that compared the pathological (detrusor muscle presence), oncological (recurrence rates) efficacy, and safety (serious adverse events [SAEs]) of TUEB and cTURBT were included. Random- and fixed-effects meta-analytic models and Bayesian approach in the network meta-analysis was used. Results: Seven randomized clinical trials (RCTs) and seven non-RCTs (NRCT), with a total of 2092 patients. The pooled 3- and 12-month recurrence risk ratios (RR) of five and four NRCTs were 0.46 (95% CI 0.29-0.73) and 0.56 (95% CI 0.33-0.96), respectively. The pooled 3- and 12-month recurrence RRs of four and seven RCTs were 0.57 (95% CI 0.25-1.27) and 0.89 (95% CI 0.69-1.15), respectively. The pooled RR for SAEs such as prolonged hematuria and bladder perforation of seven RCTs was 0.16 (95% CI 0.06-0.41) in benefit of TUEB. Seven RCTs (n = 1077) met our eligibility criteria for network meta-analysis. There was no difference in 12-month recurrence rates between hybridknife, laser, and bipolar TUEB compared with cTURBT. Contrary, laser TUEB was significantly associated with lower SAEs compared with cTURBT. Surface under the cumulative ranking curve ranking analyses showed with high certainty that laser TUEB was the best treatment option to access all endpoints. Conclusion: While NRCTs suggested a recurrence-free benefit to TUEB compared with cTURBT, RCTs failed to confirm this. Conversely, SAEs were consistently and clinically significantly better for TUEB. Network meta-analyses suggested laser TUEB has the best performance compared with other energy sources. These early findings need to be confirmed and expanded upon.
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Affiliation(s)
- Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico C Grossmann
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Hadi Mostafai
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Marek Babjuk
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, Motol University Hospital, 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Weill Cornell Medical College, New York, New York, USA.,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
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23
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Nielsen NK, Jakobsen JK, Kingo PS, Jensen JB. Potential candidates for en bloc resection among patients with primary and recurrent bladder tumours. Scand J Urol 2021; 55:366-371. [PMID: 34279178 DOI: 10.1080/21681805.2021.1954686] [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: 10/20/2022]
Abstract
INTRODUCTION Transurethral resection (TURB) is the gold standard treatment for non-muscle invasive bladder cancer (NMIBC). However, conventional TURB is possibly part of the mechanism leading to the high recurrence rate in NMIBC and the need for repeated procedures, as the method with piecemeal resection of the tumour violates basic oncological principles and compromises pathological examination. En bloc resection (EBR) could potentially overcome these flaws by improving pathological quality and thereby reducing the need for re-resections and could potentially also lower the risk of tumour seeding leading to early recurrences. With this study, we aimed to evaluate tumour characteristics in a consecutive cohort of patients undergoing conventional TURB in order to estimate the proportion of procedures eligible for EBR, findings at re-resection, and early recurrence rate. METHODS All TURBs performed at a single large University Hospital in a 12 month period were manually reviewed. Based on tumour size and appearance, patients were registered as candidates or non-candidate for EBR. RESULTS A total of 600 TURBs were reviewed. Overall, 25% of procedures were found to be eligible for EBR. The most frequent reason for not being a candidate was tumour diameter <1 cm. Re-resections were done after 10.5% of the procedures, where the residual tumour was found in 28.6% of these. Within 6 months, 21.2% had a recurrence. CONCLUSION We found approximately 25% of all TURBs to be eligible for EBR. Based on a relatively low recurrence rate, we conclude that future studies on EBR with recurrence rate as the primary endpoint will require large patient cohorts.
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24
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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.
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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
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25
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Fan J, Wu K, Zhang N, Yang T, Liu N, Jiang Y, Bai X, Wang X, He D. Green-light laser en bloc resection versus conventional transurethral resection for initial non-muscle-invasive bladder cancer: A randomized controlled trial. Int J Urol 2021; 28:855-860. [PMID: 34013615 DOI: 10.1111/iju.14592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/11/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the safety and outcomes between green-light laser en bloc resection and transurethral resection of bladder tumor. METHODS A single-center, randomized controlled trial was carried out from August 2014 to September 2018. Patients with initial non-muscle-invasive bladder cancer were randomized to green-light laser en bloc resection or transurethral resection of bladder tumor. The primary outcomes were pathological findings and perioperative events. The secondary outcome was tumor recurrence. RESULTS A total of 233 patients were randomized to the transurethral resection of bladder tumor group (117 patients) and the green-light laser en bloc resection group (116 patients). The resection time was longer in the green-light laser en bloc resection group (P = 0.022); however, no differences were identified in overall operative time (P = 0.255). Nine patients (7.7%) had an obturator nerve reflex during transurethral resection of bladder tumor. The estimated volume of blood loss was significantly lower in the green-light laser en bloc resection group (P = 0.012). The green-light laser en bloc resection group had a higher rate of T1 bladder cancer (P = 0.031). A total of 104 patients (89.7%) treated with green-light laser en bloc resection had detrusor muscle presence in the specimen, whereas 37 (31.9%) patients had the presence of muscularis mucosae, which was significantly higher than the corresponding number of transurethral resection of bladder tumor patients (P = 0.005 and 0.002, respectively). After a median follow-up period of 48 months, just five patients had tumor recurrence (three in the transurethral resection of bladder tumor group and two in the green-light laser en bloc resection group), and there was no difference between these two groups. CONCLUSIONS Compared with transurethral resection of bladder tumor, green-light laser en bloc resection is more effective due to less obturator nerve reflex and the same recurrence rate. Most importantly, green-light laser en bloc resection can provide better tumor specimens for pathological examinations.
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Affiliation(s)
- Jinhai Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Zhang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Yang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Liu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yumei Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaojing Bai
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xinyang Wang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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26
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Liu Z, Zhang Y, Sun G, Ouyang W, Wang S, Xu H, Hu H, Li F, Yang J, Wang Z, Guan W, Yu X, Hu Z, Chen Z, Wang S, Long G, Li H. Comparison of Thulium Laser Resection of Bladder Tumors and Conventional Transurethral Resection of Bladder Tumors for Non-Muscle-Invasive Bladder Cancer. Urol Int 2021; 106:116-121. [PMID: 33784709 DOI: 10.1159/000514042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The thulium laser resection of bladder tumors (TmLRBT) was increasingly used in the treatment of non-muscle-invasive bladder cancer (NMIBC) recently, and here we report the relevant outcomes of our institution to evaluate its efficacy and safety. METHODS We retrospectively collected the data of NMIBC patients who underwent either TmLRBT or transurethral resection of bladder tumor (TURBT). The baseline characteristics and perioperative outcomes were compared in these 2 groups. RESULTS The TmLRBT had a higher rate of detrusor identification than TURBT (97.4 vs. 87.6%, p = 0.001). After screening, 134 patients who underwent TmLRBT and 152 patients who received TURBT were enrolled in the analysis, and their baseline characteristics were similar. During the TURBT, 24 (15.8%) obturator nerve reflexes and 9 (5.9%) bladder perforations occurred, while none happened during the TmLRBT. After surgery, TmLRBT patients had fewer postoperative gross hematuria (38.1 vs. 96.7%, p < 0.001) and postoperative irrigation (27.6 vs. 92.7%, p < 0.001), and its irrigation duration was significantly shorter (2.3 vs. 3.3 day, p < 0.001). During the follow-up, no significant difference in the recurrence rate was detected (p = 0.315). CONCLUSIONS TmLRBT is a safer technique than conventional TURBT in the treatment of NMIBC, and it could offer better specimens for pathologic assessment while the cancer control was not compromised.
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Affiliation(s)
- Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Laukhtina E, Abufaraj M, Al-Ani A, Ali MR, Mori K, Moschini M, Quhal F, Sari Motlagh R, Pradere B, Schuettfort VM, Mostafaei H, Katayama S, Grossmann NC, Fajkovic H, Soria F, Enikeev D, Shariat SF. Intravesical Therapy in Patients with Intermediate-risk Non-muscle-invasive Bladder Cancer: A Systematic Review and Network Meta-analysis of Disease Recurrence. Eur Urol Focus 2021; 8:447-456. [PMID: 33762203 DOI: 10.1016/j.euf.2021.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 03/10/2021] [Indexed: 12/09/2022]
Abstract
CONTEXT Patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) may pose a clinical dilemma without an agreed evidence-based decision tree for personalized treatment. OBJECTIVE To perform a systematic review and network meta-analysis (NMA) to summarize available evidence on the oncologic outcomes of intravesical therapy in patients with intermediate-risk NMIBC. EVIDENCE ACQUISITION The MEDLINE, EMBASE, and ClinicalTrials.gov databases were searched in October 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Studies were deemed eligible if they reported on oncologic outcomes in patients with intermediate-risk NMIBC treated with transurethral resection of bladder tumor with and without intravesical chemotherapy or bacillus Calmette-Guérin (BCG) immunotherapy. EVIDENCE SYNTHESIS Twelve studies were included in a qualitative synthesis (systematic review); three were deemed eligible for a quantitative synthesis (NMA). An NMA of five different regimens was conducted for the association of treatment with the 5-yr recurrence risk. Chemotherapy with maintenance was associated with a lower likelihood of 5-yr recurrence than chemotherapy without maintenance (odds ratio [OR] 0.51, 95% credible interval [CI] 0.26-1.03). Immunotherapy, regardless of whether a full- or reduced-dose regimen, was not associated with a significantly lower likelihood of 5-yr recurrence when compared with chemotherapy without maintenance (OR 0.90, 95% CI 0.39-2.11 vs OR 0.93, 95% CI 0.40-2.19). Analysis of the treatment ranking revealed that chemotherapy with maintenance had the lowest 5-yr recurrence risk (P score 0.9666). CONCLUSIONS Our analysis indicates that chemotherapy with a maintenance regimen confers a superior oncologic benefit in terms of 5-yr recurrence risk compared to chemotherapy without maintenance in patients with intermediate-risk NMIBC. Regardless of the dose regimen, immunotherapy with BCG does not appear to be superior to chemotherapy in patients with intermediate-risk NMIBC in term of disease recurrence. However, owing to the lack of comparative studies, there is an unmet need for well-designed, large-scale trials to validate our findings and generate robust evidence on disease recurrence and progression. PATIENT SUMMARY A maintenance schedule of chemotherapy reduces the rate of long-term recurrence of bladder cancer that has not invaded the bladder muscle. Chemotherapy inserted directly into the bladder and immunotherapy without maintenance schedules seem to have limited benefit in preventing cancer recurrence.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - 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
| | - Abdallah Al-Ani
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Mustafa Rami Ali
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele, Milan, Italy
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - 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
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nico C Grossmann
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Yang Y, Liu C, Yan X, Li J, Yang X. En Bloc Tumor Resection, Optical Molecular Imaging, and the Potential Synergy of the Combination of the Two Techniques in Bladder Cancer. Front Oncol 2021; 11:638083. [PMID: 33796465 PMCID: PMC8008058 DOI: 10.3389/fonc.2021.638083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
Although transurethral resection of bladder tumor is the golden standard for the treatment of non-muscle invasive bladder cancer, this surgical procedure still has some serious drawbacks. For example, piecemeal resection of tumor tissue results in exfoliated tumor cells dissemination and implantation, and fragmented tumor specimens make it difficult for pathologists to accurately assess the pathological stage and histologic grade. En bloc tumor resection follows the basic principle of oncological surgery and provides an intact tumor specimen containing detrusor muscle for pathologists to make accurate histopathological assessment. However, there is no robust clinical evidence that en bloc tumor resection is superior to conventional resection in terms of oncological outcomes. Considering the high recurrence rate, small or occult tumor lesions may be overlooked and incomplete tumor resection may occur during white light cystoscopy-assisted transurethral resection. Molecular fluorescent tracers have the ability to bind tumor cells with high sensitivity and specificity. Optical molecular imaging mediated by it can detect small or occult malignant lesions while minimizing the occurrence of false-positive results. Meanwhile, optical molecular imaging can provide dynamic and real-time image guidance in the surgical procedure, which helps urologists to accurately determine the boundary and depth of tumor invasion, so as to perform complete and high-quality transurethral tumor resection. Integrating the advantages of these two technologies, optical molecular imaging-assisted en bloc tumor resection shows the potential to improve the positive detection rate of small or occult tumor lesions and the quality of transurethral resection, resulting in high recurrence-free and progression-free survival rates.
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Affiliation(s)
- Yongjun Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Chao Liu
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaoting Yan
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Jiawei Li
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaofeng Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
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Safety and efficacy of thulium laser resection of bladder tumors versus transurethral resection of bladder tumors: a systematic review and meta-analysis. Lasers Med Sci 2021; 36:1807-1816. [PMID: 33604772 DOI: 10.1007/s10103-021-03272-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
The thulium laser resection of bladder tumor (TmLRBT) is widely used in the treatment of non-muscle-invasive bladder cancer (NMIBC), and we conduct this study to compare the safety and efficacy of TmLRBT with transurethral resection of bladder tumor (TURBT). A comprehensive literature research was conducted using multiple databases, and comparative studies evaluating the safety and efficacy of TmLRBT and TURBT were included. For continuous outcomes, the weighted mean difference (WMD) was used to measure the difference, whereas the risk ratio (RR) with a 95% confidence interval (CI) was calculated for binary variables. Overall, ten studies with 1558 patients enrolled were included in the meta-analysis. The baseline characteristics of two groups were comparable. The operative time (p = 0.24) and catheterization time (p = 0.41) of two groups were similar but the TmLRBT group had a shorter length of hospital stay (p = 0.04). TmLRBT was related to fewer intraoperative complications including obturator nerve reflex (p < 0.001) and bladder perforation (p < 0.001). Although the rate of postoperative irrigation did not significantly differ in our analysis (p = 0.28), the TmLRBT was related to a significantly shorter duration of irrigation (p = 0.004). Besides, the TmLRBT group had a higher rate of identification of detrusor (p = 0.02). However, TmLRBT did not suggest significantly better cancer control than TURBT including the overall recurrence (p = 0.052), 1-year recurrence (p = 0.23), and 2-year recurrence (p = 0.40). Compared with conventional TURBT, the TmLRBT showed superior safety and non-inferior efficacy in cancer control. TmLRBT could also provide high-quality specimens for pathology diagnosis; therefore, it is an as effective option for NMIBC.
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Yasui M, Ohta JI, Aoki S, Tajirika H, Terao H, Funahashi M, Moriyama M, Hayashi H. Prognosis of patients with T1 bladder cancer after en bloc transurethral resection of bladder tumor stratified by invasion to the level of the muscularis mucosa. Int Urol Nephrol 2021; 53:1105-1109. [PMID: 33387223 DOI: 10.1007/s11255-020-02772-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the prognosis of patients with pT1 bladder cancer who underwent en bloc resection of bladder tumors (ERBTs), stratified by invasion to the muscularis mucosa (MM) level. METHODS Among 64 specimens obtained by ERBT with bipolar energy from patients with pT1 bladder cancer, MM was detected in 61 specimens. Thus, 61 specimens were included in this retrospective study. Patients were stratified by invasion to the MM level (pT1a, invasion above the MM level; pT1b, invasion within the MM level; and pT1c, invasion beyond the MM level). In specimens with discontinuous MM, invasion to the MM level was predicted from the dispersed MM in the specimen. The primary endpoints were progression-free survival (PFS) and cancer-specific survival (CSS). RESULTS Progression occurred in 2/39 patients with pT1a (5.1%), 1/6 patients with pT1b (16.7%), and 6/16 patients with pT1c cancer (37.5%). Cancer death occurred in 1/39 patients with pT1a (2.6%), 0/7 patients with pT1b, and 3/16 patients with pT1c cancer (18.8%). Patients with pT1a or pT1b cancer had a significantly better prognosis than those with pT1c cancer. On univariate analysis, tumor size ≥ 3 cm and pT1c were significantly associated with shorter PFS. On multivariate analysis, only pT1c was independently associated with shorter PFS. CONCLUSION This is the first study evaluating the prognosis by T1 substaging based on invasion to the MM level using ERBT specimens. ERBT provided high-quality specimens for diagnosing the MM and showed poor prognosis in pT1c bladder cancer. ERBT could be an appropriate surgical approach for an accurate diagnosis and prognosis of the T1 bladder cancer substage.
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Affiliation(s)
- Masato Yasui
- Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan.
| | - Jun-Ichi Ohta
- Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Shuntaro Aoki
- Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Hironao Tajirika
- Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Hideyuki Terao
- Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Makoto Funahashi
- Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Masatoshi Moriyama
- Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Hiroyuki Hayashi
- Department of Pathology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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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.
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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
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Chen G, Yang T, Shao Q, Zhang M, Yang B, Zhang P, Fan J. Sub-Staging-Specific Differences in Recurrence-Free, Progression-Free, and Cancer-Specific Survival for Patients with T1 Bladder Cancer: A Systematic Review and Meta-Analysis. Urol Int 2020; 104:580-586. [PMID: 32610323 DOI: 10.1159/000506238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The efficiency of the T1 sub-staging system on categorizing bladder cancer (BC) patients into subgroups with different clinical outcomes was unclear. We summarized relevant evidences, including recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS), to analyze the prognostic significance of T1 sub-stage. METHODS Systematic literature searches of MEDLINE, EMBASE, and the Cochrane Library were performed. We pooled data on recurrence, progression, and CSS from 35 studies. RESULTS The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) indicated the difference in RFS between T1a sub-stage and T1b sub-stage (HR 1.28, 95% CI 1.14-1.43, p < 0.001). The significant difference was observed in PFS between the 2 arms (HR 2.18, 95% CI 1.95-2.44, p < 0.001). Worse CSS was found in T1b patients than in T1a patients (HR 1.36, 95% CI 1.21-1.54, p < 0.001). CONCLUSIONS T1 sub-staging system based on the invasion depth into muscularis mucosae can be a significant prognostic factor for RFS, PFS, and CSS of patients with T1 BC. Urologists and pathologists are encouraged to work together to give a precise sub-stage classification of T1 BC, and T1 sub-staging system should be a routine part of any histopathological report when possible. Different treatment strategies need to be developed for both T1a BC and T1b BC.
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Affiliation(s)
- Guanqiu Chen
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Yang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiuya Shao
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengzhao Zhang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Yang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pu Zhang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,
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Xu J, Wang C, Ouyang J, Sun J, Hu C. Efficacy and Safety of Transurethral Laser Surgery Versus Transurethral Resection for Non-Muscle-Invasive Bladder Cancer: A Meta-Analysis and Systematic Review. Urol Int 2020; 104:810-823. [PMID: 32460292 DOI: 10.1159/000506655] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of transurethral laser surgery and transurethral resection of a bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC). MATERIAL AND METHODS A research was carried out in Medline via PubMed, EMBASE, the Cochrane Library, and Web of Science up to October 20, 2019, to identify articles related to transurethral laser surgery and TURBT for NMIBC. All analyses were done using RevMan5.3 and Stata14. RESULTS A total of 17 studies involving 2,439 participants were included. The analysis showed no significant difference in operation times (mean difference = -0.2; 95% CI -2.29 to 1.89; p = 0.85) or occurrences of urethral stricture (OR = 0.7; 95% CI 0.24-2.06; p = 0.52). Transurethral laser surgery was associated with a lower incidence of obturator nerve reflex (OR = 0.04; 95% CI 0.02-0.09; p < 0.00001) and bladder perforation (OR = 0.09; 95% CI 0.04-0.23; p < 0.00001), a higher rate of detrusor muscle acquisition (OR = 5.28; 95% CI 2.42-11.49; p < 0.0001), shorter catheterization (mean difference = -1.05; 95% CI -1.41 to -0.68; p < 0.00001) and hospitalization times (mean difference = -0.96; 95% CI -1.59 to -0.33; p = 0.003), and lower rates of bladder irrigation (OR = 0.21; 95% CI 0.13-0.35; p < 0.00001) and recurrence both at 12 months (OR = 0.66; 95% CI 0.48-0.9, p = 0.008) and at 24 months (OR = 0.6; 95% CI 0.41-0.86; p = 0.005). CONCLUSIONS Transurethral laser surgery for NMIBC, as compared to TURBT, is associated with a lower incidence of complications, a lower recurrence rate, and faster postoperative recovery.
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Affiliation(s)
- Jiangnan Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chao Wang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China,
| | - Jiale Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Can Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Outcome of simultaneous thulium laser enucleation of bladder tumor and prostate in patients with non-muscle invasive bladder tumor and benign prostatic hyperplasia: a matched-pair comparison with a long-term follow-up. World J Urol 2020; 39:105-111. [PMID: 32215675 DOI: 10.1007/s00345-020-03158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To access the surgical and oncological outcomes of simultaneous thulium laser enucleation of bladder tumor (ThuLEBT) and thulium laser enucleation of prostate (ThuLEP) in patients with non-muscle invasive bladder tumor (NMIBC) and benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between June 2009 and June 2017, 118 men with NMIBC who underwent simultaneous ThuLEBT and ThuLEP and fulfilled the inclusion criteria were matched with 118 patients who received ThuLEBT alone. Clinicopathological parameters, surgical outcome data and oncological outcomes were retrospectively analyzed and compared. RESULTS The patients who underwent simultaneous ThuLEBT and ThuLEP experienced a longer length of operation time (70.4 vs. 25.5 min; p < 0.001), but there were no statistically significant differences in catheterization period, hospital stay and complication between the two groups. At a mean follow-up of 58.7 and 55.8 months in ThuLEBT/ThuLEP group and ThuLEBT group, no significant differences in overall recurrence rates, progression rates, recurrence in the bladder neck/prostatic fossa and mean elapsed time to recurrence were detected. The 5-year recurrence-free probability was 73.2% for ThuLEBT/ThuLEP and 69.2% for ThuLEBT (p = 0.361). CONCLUSIONS Our results indicate that simultaneous ThuLEBT and ThuLEP can be safely performed without increasing the surgical risk and the risk of tumor recurrence and progression in patients with NMIBC and BPH, and it may be preferred alternative for select patients.
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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.
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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.
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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.
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van Putten K, Vernooij RWM, Meijer RP, Zhu X. En-bloc resection versus conventional transurethral resection for patients with non-muscle-invasive bladder cancer. Hippokratia 2019. [DOI: 10.1002/14651858.cd013473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kim van Putten
- University Medical Center Utrecht; Department of Oncological Urology; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Robin WM Vernooij
- University Medical Center Utrecht; Department of Nephrology and Hypertension and Julius Center for Health Sciences and Primary Care; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Richard P Meijer
- University Medical Center Utrecht; Department of Oncological Urology; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Xiaoye Zhu
- Radboudumc, University Medical Center; Department of Urology; Nijmegen Netherlands
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Defidio L, Antonucci M, De Dominicis M, Fuchs G, Patel A. Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center. J Endourol 2019; 33:902-908. [PMID: 31422699 DOI: 10.1089/end.2019.0308] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction and Objectives: To evaluate ablative safety and efficacy of thulium-holmium:YAG (TL-HL:YAG) duo laser in renal conserving retrograde intrarenal surgery (RC-RIRS) in upper tract urothelial carcinoma (UTUC). Materials and Methods: A retrospective study was performed on 178 consecutive patients referred for consideration of RC-RIRS UTUC-eLA (endoscopic laser ablation) in a tertiary center (January 2005 to December 2018). Key data were recorded using a standardized study proforma. Results: After endodiagnostic procedure, 42 declined rigorous endosurveillance protocol and went elsewhere for alternative treatment, leaving 136 patients, of whom 35 patients dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This was left with 101 candidates who continued UTUC conservative management (intention-to-treat [ITT] population). Mean follow-up (FU) for these 101 patients was 28.7 months. At last FU (range 3-144 months), 70 patients (69.3%) were recurrence free, 22 (21.8%) had endoscopically treated recurrences, and a further 9 (8.9%) had undergone RNU. In the ITT population, kidney-preserving rate was 91%, whereas in imperative indications, it was 87.5%. Clavien-Dindo grade I complications only (self-limiting hematuria) were reported in 10%. Conclusions: Over a 13-year period, RC-RIRS UTUC treatment with the TL-HL:YAG duo laser was safe and oncologically noninferior to alternative combination laser energy technologies used for this indication.
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Affiliation(s)
| | | | | | - Gerhard Fuchs
- Kech School of Medicine USC, Los Angeles, California
| | - Anup Patel
- Department of Urology, Spire Roding, London, United Kingdom
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Su H, Jiang H, Tao T, Kang X, Zhang X, Kang D, Li S, Li C, Wang H, Yang Z, Zhang J, Li C. Hope and challenge: Precision medicine in bladder cancer. Cancer Med 2019; 8:1806-1816. [PMID: 30907072 PMCID: PMC6488142 DOI: 10.1002/cam4.1979] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/20/2018] [Accepted: 01/01/2019] [Indexed: 12/21/2022] Open
Abstract
Bladder cancer (BC) is a complex disease and could be classified into nonmuscle‐invasive BC (NMIBC) or muscle‐invasive BC (MIBC) subtypes according to the distinct genetic background and clinical prognosis. Until now, the golden standard and confirmed diagnosis of BC is cystoscopy and the major problems of BC are the high rate of recurrence and high costs in the clinic. Recent molecular and genetic studies have provided perspectives on the novel biomarkers and potential therapeutic targets of BC. In this article, we provided an overview of the traditional diagnostic approaches of BC, and introduced some new imaging, endoscopic, and immunological diagnostic technology in the accurate diagnosis of BC. Meanwhile, the minimally invasive precision treatment technique, immunotherapy, chemotherapy, gene therapy, and targeted therapy of BC were also included. Here, we will overview the diagnosis and therapy methods of BC used in clinical practice, focusing on their specificity, efficiency, and safety. On the basis of the discussion of the benefits of precision medicine in BC, we will also discuss the challenges and limitations facing the non‐invasive methods of diagnosis and precision therapy of BC. The molecularly targeted and immunotherapeutic approaches, and gene therapy methods to BC treatment improved the prognosis and overall survival of BC patients.
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Affiliation(s)
- Hongwei Su
- Department of Urology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Haitao Jiang
- Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, China
| | - Tao Tao
- Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Department of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Xing Kang
- Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Xu Zhang
- Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Danyue Kang
- Michigan State University, East Lansing, Michigan
| | - Shucheng Li
- Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Chengxi Li
- Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Haifeng Wang
- Department of Urology, The Second Affliated Hospital of Kunming Medical University, Kunming, China
| | - Zhao Yang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Jinku Zhang
- Department of pathology, First Central Hospital of Baoding, Baoding, Hebei, China
| | - Chong Li
- Department of Urology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China.,Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Department of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China.,Beijing Jianlan Institute of Medicine, Beijing, China
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40
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41
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Liu J, Jiao Y, Niu Y, Yu L, Ji M, Zhang S. Preliminary study of 1940 nm thulium laser usage in peroral endoscopic myotomy for achalasia. Dis Esophagus 2018; 31:4794750. [PMID: 29342262 DOI: 10.1093/dote/dox132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
Abstract
Esophageal achalasia is a type of motility disorder characterized by incomplete relaxation of lower esophageal sphincter (LES) and absence of esophageal peristalsis. Peroral endoscopic myotomy (POEM) is a new treatment option for achalasia that is less invasive, more effective, and safe as compared to surgery. High-frequency electrotome is commonly used in POEM, but takes longer time to make the tunnel in the esophagus and causes many complications. The thulium laser decreases the risk of bleeding and perforation in endoscopy but has not been reported in digestive diseases, especially in POEM. Therefore, the aim of this study is to evaluate the feasibility of the 1940 nm thulium laser in POEM. From March 2015 to August 2015, five patients with achalasia at the Digestive department, Beijing Friendship Hospital, Capital Medical University, Beijing, China were included. Before the procedure, the patients' gender, age, and duration of symptoms were recorded. Eckardt symptom score and LES thickness, which measured by endoscopic ultrasonography, were recorded. While the subtypes of achalasia (according to the Chicago classification), lower esophagus sphincter resting pressure (LESRP) and integrated relaxation pressure (IRP) were measured by HRM for all patients. Barium esophagram was also used to rule out anatomical lesions, esophageal varices, or neoplasia, which may cause similar symptoms. All examinations were performed one week before POEM. POEM was performed with the 1940 nm thulium laser under general anesthesia. Eckardt score, procedure duration, myotomy length, and complications were recorded one week after POEM. All the patients were followed-up at two weeks and four weeks after POEM. POEM was successfully performed in all five patients. The mean age of the patients was 38.8 years (24-54 years). Achalasia subtypes were type I (n = 1), II (n = 2), and III (n = 2). The operation duration was 186, 180, 111, 75, and 126 minutes for the five cases. Pre/postprocedure Eckardt scores were 3/0, 7/0, 5/1, 6/0, and 9/0. Pre/postprocedure LESRP (mmHg) were 45.3/26.4, 18.0/1.1, 25.8/10.4, 16.5/11.2, and 24.2/20.8. Pre/postprocedure IRP (mmHg) were 27.3/15.5, 15.4/4.2, 5.7/6.8, 15.5/10.1, and 13.1/14, respectively. No adverse events occurred during the procedure. After POEM, subcutaneous emphysema occurred in case 1 on the first day, which relieved spontaneously after two days without special intervention. Infection occurred in case 5 on the day of POEM was healed with antibiotics three days later. The 1940 nm thulium laser is feasible for POEM procedure. Further studies are needed to determine whether the 1940 nm thulium laser is better than high-frequency electrotome.
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Affiliation(s)
- J Liu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Y Jiao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Y Niu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - L Yu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - M Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - S Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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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]
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43
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Thulium laser treatment for bladder cancer. Asian J Urol 2016; 3:130-133. [PMID: 29264180 PMCID: PMC5730823 DOI: 10.1016/j.ajur.2016.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/11/2016] [Accepted: 05/17/2016] [Indexed: 01/19/2023] Open
Abstract
Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer. Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure. We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes. Literature evidence suggests that thulium laser techniques including smooth incision, tissue vaporization, and en bloc resection represent feasible, safe, and effective procedures in the treatment of bladder cancer. Moreover, these techniques allow improved specimen orientation and accurate determination of invasion depth, facilitating correct diagnosis, restaging, and re-evaluation of the need for a second resection. Nonetheless, large-scale multicentre studies with longer follow-up are warranted for a robust assessment. The present review is meant as a quick reference for urologists.
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