1
|
Enikeev D, Morozov A, Shpikina A, Fajkovic H, Baniel J, Herrmann TRW. A 10-year renaissance of en bloc resection of bladder tumors (ERBT): Are we approaching the peak or is it back to the trough? World J Urol 2023; 41:2607-2615. [PMID: 37244879 DOI: 10.1007/s00345-023-04439-3] [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: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The number of studies suggesting that en bloc resection of bladder tumor (ERBT) is superior to transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) management is growing. The aim of this review is to discuss the features of these procedures and to determine the prospects of en bloc in NMIBC management. MATERIALS AND METHODS We conducted a literature search using two databases (Medline and Scopus) and included any research which reported ERBT outcomes. RESULTS The lasers with minimal tissue penetration depth are becoming the main tool for ERBT. Unfortunately, most of the systematic reviews continue to be characterized by high heterogeneity. However, recent studies indicate that ERBT may have the edge when it comes to the detrusor muscle rate and the quality of the histological specimen. ERBT may favor in terms of in-field relapse, but its rate in the studies varies greatly. As for out-field relapse-free survival, the data are still lacking. The strongest evidence supports that ERBT is superior to TURBT in complications rate (bladder perforation). ERBT is feasible irrespective to tumor size and location. CONCLUSIONS ERBT has gained in momentum with the increasingly widespread use of this kind of laser surgery. The introduction of novel sources (TFL and Thulium:YAG pulsed laser) will definitely affect how the field develops and will result in further improvements in safety and precision. The latest trials make us more certain in our belief that ERBT will be beneficial in terms of histological specimen quality, relapse rate and complications rate.
Collapse
Affiliation(s)
- Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland
- Department of Urology, Stellenbosch University, Western Cape, South Africa
- Hannover Medical School, MHH Carl Neuberg Str. 1, 30625, Hannover, Germany
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Symeonidis EN, Lo KL, Chui KL, Vakalopoulos I, Sountoulides P. En bloc resection of bladder tumors: challenges and unmet needs in 2021. Future Oncol 2022; 18:2545-2558. [PMID: 35642479 DOI: 10.2217/fon-2021-1228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Non-muscle invasive bladder cancer accounts for the majority of new bladder cancer diagnoses, and endoscopic transurethral resection of bladder tumor (TURBT) represents the standard-of-care. Although a relatively safe and common procedure, TURBT is often hampered by the questionable quality of resection. The evolution of surgical techniques has brought en bloc resection of bladder tumor (ERBT) to the forefront. ERBT has emerged as an alternative to conventional TURBT, incorporating a more delicate en bloc sculpting and tumor excision, in contrast to 'piecemeal' resection by conventional TURBT. ERBT appears safe, feasible and effective with demonstrably higher rates of detrusor muscle in the pathologic specimen, all while providing better staging and obviating the need for a re-TURBT in selected patients. However, the method's adoption in the field is still limited. This review summarizes the recent evidence relevant to ERBT while further highlighting the technique's limitations and unmet needs.
Collapse
Affiliation(s)
- Evangelos N Symeonidis
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| | - Ka-Lun Lo
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Ka-Lun Chui
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Ioannis Vakalopoulos
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| | - Petros Sountoulides
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| |
Collapse
|
4
|
Abstract
Laser technology has been a breakthrough in urology. The new era in endocorporeal laser lithotripsy has recently begun in mid-2020, where promising technologies tested in vitro have reached their approval for clinical use and, in that way, have made it possible to confirm their safety and advantages in the real world, for the patient and for the urologist.
Collapse
Affiliation(s)
- Olivier Traxer
- Sorbonne University, GRC Urolithiasis no. 20, Tenon Hospital, Paris F-75020, France; Sorbonne University, Department of Urology AP-HP, Tenon Hospital, Paris F-75020, France.
| | - Mariela Corrales
- Sorbonne University, GRC Urolithiasis no. 20, Tenon Hospital, Paris F-75020, France; Sorbonne University, Department of Urology AP-HP, Tenon Hospital, Paris F-75020, France
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Kopel J, Sharma P. En bloc transurethral resection of bladder tumor: A review of the literature. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415821993734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bladder cancer remains one of the most common malignancies of the genitourinary tract. Transurethral resection of the bladder tumor (TURBT) via cystoscopy with examination under anesthesia remains the primary method for determining the diagnosis and clinical stage of bladder cancer. Given the substantial cost of treatment and risk of bladder cancer recurrence after TURBT, novel approaches to transurethral resection, such as the en bloc technique, have been developed in an attempt to address these limitations. In this review, we examined the postoperative and oncological outcomes of en bloc TURBT compared to traditional resection techniques. Further prospective clinical studies, however, are still necessary to determine whether these alternative technologies or surgical techniques may improve treatment in bladder cancer patients. Level of evidence: Not applicable.
Collapse
Affiliation(s)
- Jonathan Kopel
- Department of Urology, Texas Tech University Health Sciences Center, USA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, USA
| |
Collapse
|
7
|
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: 7] [Impact Index Per Article: 2.3] [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.
Collapse
|
8
|
Bozzini G, Gastaldi C, Besana U, Calori A, Casellato S, Parma P, Pastore A, Macchi A, Breda A, Gozen A, Skolarikos A, Herrmann T, Scoffone C, Eissa A, Sighinolfi MC, Rocco B, Buizza C, Liatsikos E. Thulium-laser retrograde intra renal ablation of upper urinary tract transitional cell carcinoma: an ESUT Study. Minerva Urol Nephrol 2020; 73:114-121. [PMID: 32026668 DOI: 10.23736/s2724-6051.20.03689-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Radical nephroureterectomy (RNU) is the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC); however, patients presenting with small low-grade UTUC have been treated by flexible ureteroscopic laser ablation with good outcomes. Different types of laser have been discussed in the literature including Holmium and Neodymium lasers. We aimed to assess the safety and efficacy of Thulium laser (Tm:YAG) in the ureteroscopic ablation of UTUC. METHODS A retrospective observational multicentre study of patients diagnosed with papillary UTUC between January 2015 and December 2016 was carried out. All patients underwent ureteroscopic biopsy of the UTUC followed by Tm:YAG ablation. Based on the histopathological grade of the tumor, patients were counseled to undergo either RNU (high- grade tumors) or conservative management and follow-up (low-grade tumor). RESULTS RNU was performed in 31 patients, while the remaining 47 patients (undergone Tm:YAG ablation only) were followed up for a mean of 11.7 months with only 19.2% of patients showing upper tract recurrence and no patients showed postoperative ureteral strictures. Limitations include the short follow-up and retrospective nature of the study. CONCLUSIONS On the short term, thulium Laser ablation of UTUC is safe and feasible especially in low-grade UTUC.
Collapse
Affiliation(s)
- Giorgio Bozzini
- ESUT (European section for UroTechnology), Arnehm, the Netherlands - .,Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy -
| | | | - Umberto Besana
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Alberto Calori
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Stefano Casellato
- Department of Urology, Istituti Clinici Zucchi, Monza, Monza-Brianza, Italy
| | - Paolo Parma
- Department of Urology, Poma Hospital, Mantua, Italy
| | | | - Alberto Macchi
- Department of Urology, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Alberto Breda
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Puigvert Foundation, Barcelona, Spain
| | - Ali Gozen
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, University of Heidelberg, Heilbronn, Germany
| | - Andreas Skolarikos
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Athens Univerity, Athens, Greece
| | - Thomas Herrmann
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
| | - Cesare Scoffone
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Cottolengo Hospital, Turin, Italy
| | - Ahmed Eissa
- Department of Urology, Baggiovara Hospital, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Bernardo Rocco
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Baggiovara Hospital, Modena, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Evangelos Liatsikos
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, University of Patras, Patras, Greece
| |
Collapse
|
9
|
Tao W, Sun C, Yao Q, Fu K, Shan Y, Zhang Y, Xue B, Yang D. The clinical study of en bloc transurethral resection with 980 nm laser for treatment of primary non-muscle invasive bladder cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:563-571. [PMID: 32224536 DOI: 10.3233/xst-190616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To elevate safety and efficacy of en bloc transurethral resection with 980 nm laser as treatment for primary non-muscle-invasive bladder cancer (NMIBC). METHODS Total 84 cases were enrolled in this study. Among them, 36 and 48 cases underwent treatment using the 980 nm laser and the traditional TUR-BT procedure, respectively. The peri-operative characteristics (tumor size, tumor multiplicity, tumor grade, etc.) and intra-operative complications (obturator nerve reflex, bladder perforation, bladder irrigation, etc.) were recorded and compared between the two groups. RESULTS There are no significant difference in baseline characteristics between laser and TUR-Bt treatment groups. Operation time also has no significant difference in two groups. Obturator nerve reflex and bladder perforation were noted in 6 patients and in 3 patients during TUR-Bt group, respectively. No obturator nerve reflex and bladder perforation were observed in the laser group. The patients who need bladder irrigation was lower in laser group than in TUR-Bt group. There were no significant differences in catheterization time and hospitalization time between two groups. No significant difference in the overall recurrence rate were observed among the two groups during the follow-up periods. CONCLUSION En bloc transurethral resection using 980 nm laser is an effective and safe treatment option for non-muscle-invasive bladder cancer. Compared to the traditional TUR-Bt procedure, the procedure using 980 nm laser has fewer perioperative complications and similar oncological results.
Collapse
Affiliation(s)
- Wei Tao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanyang Sun
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiu Yao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Fu
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuxi Shan
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Boxin Xue
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dongrong Yang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
10
|
Technical developments in transurethral resection of bladder tumours. Contemp Oncol (Pozn) 2019; 23:195-201. [PMID: 31992950 PMCID: PMC6978765 DOI: 10.5114/wo.2019.91530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/04/2019] [Indexed: 11/26/2022] Open
Abstract
Bladder cancer is one of the most common malignancies worldwide. The transurethral resection of bladder tumour (TURB) remains the gold standard in both diagnostics and treatment. Because of the importance of TURB in bladder cancer management and the fact that TURB is one of the most commonly performed urologic procedures, it is the subject of continuous technological development. The latest advances in the field of endourology are aimed at increasing surgical accuracy and thus reducing the risk of bladder tumour recurrence and progression. However, despite the constant progress in technology and technique, there are still a lack of good quality data showing the superiority of any of the methods. The aim of this paper is to present available data on new technological developments in surgical technique of TURB. Advantages and disadvantages of currently available methods are discussed, and literature showing their effectiveness and safety is shown.
Collapse
|
11
|
Ouzaid I, Panthier F, Hermieu JF, Xylinas E. Contemporary surgical and technical aspects of transurethral resection of bladder tumor. Transl Androl Urol 2019; 8:21-24. [PMID: 30976564 PMCID: PMC6414345 DOI: 10.21037/tau.2019.01.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To date, transurethral resection of bladder tumor (TURBT) remains the gold standard of staging urothelial cancer of the bladder and treating non-muscle invasive bladder cancer (NMIBC). The primary goal of the procedure includes a proper diagnosis, correct staging, and removal all lesions. Herein, we discuss major contemporary surgical and technical aspects of including en bloc resection, bipolar and laser resection as well as quality control of TURBT.
Collapse
Affiliation(s)
- Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris, Paris Diderot University, Paris, France
| | - Fréderic Panthier
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris, Paris Diderot University, Paris, France
| | - Jean-François Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris, Paris Diderot University, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris, Paris Diderot University, Paris, France
| |
Collapse
|
12
|
Lu M, Liu X. Comparison of GreenLight Laser Photoselective Vaporization and Thulium Laser Enucleation for Nonmuscle Invasive Bladder Cancer. Photomed Laser Surg 2018; 36:383-385. [PMID: 29717908 DOI: 10.1089/pho.2018.4440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meihua Lu
- Department of Medical Records, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaolong Liu
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
13
|
|
14
|
Xu H, Ma J, Chen Z, Yang J, Yuan H, Wang T, Liu J, Yang W, Ye Z. Safety and Efficacy of En Bloc Transurethral Resection With 1.9 µm Vela Laser for Treatment of Non-Muscle-invasive Bladder Cancer. Urology 2017; 113:246-250. [PMID: 29198850 DOI: 10.1016/j.urology.2017.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/07/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of 1.9 µm Vela laser in treatment of primary non-muscle-invasive bladder cancer. METHODS The data of the patients with non-muscle-invasive bladder cancer treated by either en bloc transurethral resection with 1.9 µm Vela laser (n = 26) or conventional transurethral resection of bladder tumor (n = 44) were analyzed retrospectively. The preoperative characteristics and intraoperative complications were compared in the 2 groups. RESULTS Patients who were treated by 1.9 µm Vela laser obtained a higher rate of specimens meeting the requirements of pathologic assessment for tumor staging compared with the patients treated by conventional transurethral resection of bladder tumor. No obturator nerve reflex and bladder perforation occurred during surgery in the 1.9 µm Vela laser group. However, 7 patients in the conventional transurethral resection of bladder tumor group encountered obturator nerve reflex, and 3 of them encountered bladder perforation (P <.05). There were no significant differences between the 2 groups in operative duration and transfusion rate. Patients in the 1.9 µm Vela laser group had shorter postoperative continuous bladder irrigation time than that in the conventional transurethral resection of bladder tumor group. There was no significant difference in the overall recurrence rate between the 2 groups during the follow-up periods. CONCLUSION En bloc transurethral resection with 1.9 µm Vela laser in the treatment of non-muscle-invasive bladder cancer demonstrates an advantage over conventional transurethral resection of bladder tumor in reducing intraoperative complications, improving the quality of the specimens admitted for pathologic assessment, and shortening the duration of postoperative continuous bladder irrigation.
Collapse
Affiliation(s)
- Hao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jun Ma
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhong Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Huixin Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Weimin Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| |
Collapse
|
15
|
Kramer MW, Altieri V, Hurle R, Lusuardi L, Merseburger AS, Rassweiler J, Struck JP, Herrmann TR. Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer. Eur Urol Focus 2017; 3:567-576. [DOI: 10.1016/j.euf.2016.12.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/29/2022]
|
16
|
|
17
|
Preliminary Development of a Continuum Dual-Arm Surgical Robotic System for Transurethral Procedures. INTELLIGENT ROBOTICS AND APPLICATIONS 2017. [DOI: 10.1007/978-3-319-65292-4_27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
18
|
Kamal W, Kallidonis P, Koukiou G, Amanatides L, Panagopoulos V, Ntasiotis P, Liatsikos E. Stone Retropulsion with Ho: YAG and Tm: YAG Lasers: A Clinical Practice-Oriented Experimental Study. J Endourol 2016; 30:1145-1149. [DOI: 10.1089/end.2016.0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Wissam Kamal
- Department of Urology, University of Patras, Patras, Greece
| | | | - Georgia Koukiou
- Electronics Laboratory, Department of Physics, University of Patras, Patras, Greece
| | | | | | | | | |
Collapse
|
19
|
Chen J, Zhao Y, Wang S, Jin X, Sun P, Zhang L, Wang M. Green-light laser en bloc resection for primary non-muscle-invasive bladder tumor versus transurethral electroresection: A prospective, nonrandomized two-center trial with 36-month follow-up. Lasers Surg Med 2016; 48:859-865. [PMID: 27454755 DOI: 10.1002/lsm.22565] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of LBO laser en bloc resection compared with transurethral electroresection (TURBT) for the treatment of primary non-muscle-invasive bladder tumors. METHODS From September 2010 to February 2012, a prospective, nonrandomized two-center trial was performed. A total of 158 patients (83 underwent laser resection and 75 TURBT) were included in the present study. The preoperative, intraoperative, and postoperative clinical characteristics were recorded and compared in the two groups. RESULTS There were no differences with the preoperative characteristics between the patients in the two groups. The mean operative time was 21.46 ± 10.42 minutes for laser resection and 27.47 ± 15.30 minutes for TURBT (P = 0.004). LBO laser group was also associated with less hemoglobin decrease compared with TURBT group (0.87 ± 0.28 g/ml vs. 1.00 ± 0.33 g/ml, P = 0.009). Obturator nerve reflection was absent during laser resection, whereas was observed in nine patients during TURBT (P = 0.001). Two patients in the TURBT group suffered bladder perforation. Three patients in TURBT group and one patient in LBO laser group experienced urethral stricture. The recurrence-free survival rate did not differ significantly between two groups after 36 months follow-up. CONCLUSIONS The results of our trial have shown that LBO laser en bloc resection is feasible, safe, and effective alternative for the treatment of primary non-muscle-invasive bladder tumors. Besides, it can provide intact specimen for the pathologic diagnosis. Lasers Surg. Med. 48:859-865, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ji Chen
- School of Medicine, Shandong University, Jinan, People's Republic of China.,Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Yong Zhao
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Sijun Wang
- Department of Urology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Xunbo Jin
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Peng Sun
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Longyang Zhang
- Department of Urology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Muwen Wang
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China.
| |
Collapse
|
20
|
A Pilot Study of Vela Laser for En Bloc Resection of Papillary Bladder Cancer. Clin Genitourin Cancer 2016; 15:e311-e314. [PMID: 28110833 DOI: 10.1016/j.clgc.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/05/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The present study evaluated the safety and efficacy of the Vela laser for en bloc resection of papillary bladder tumors. MATERIALS AND METHODS From January 2013 to August 2014, 38 patients underwent en bloc resection with the Vela laser and a 26F continuous flow resectoscope or 18F flexible cystoscope. Random cold forceps biopsy samples were also taken. The total operation time, pathologic result, and intraoperative and postoperative complications were recorded. Each patient was followed up for ≥ 1 year. RESULTS The average total operation time was 23 minutes. The en bloc resection of all tumors was successful, with 2 cases located at the bladder dome requiring the use of a flexible cystoscope for better management. No complications occurred during or after surgery. All resected tumors were intact with the detrusor muscle layer and architecture available for pathologic evaluation. One patient with stage T2b tumor underwent laparoscopic cystectomy 1 week after the initial surgery. At a median follow-up period of 21.8 months, the recurrence rate at 12 months was 21.6% (8 of 37). CONCLUSION The results of our study have shown that the Vela laser is an effective, feasible, and safe thulium laser for en bloc bladder tumor resection. It was associated with negligible complications and allows accurate pathologic evaluation. The Vela laser can serve as an alternative treatment method for nonmuscle-invasive bladder cancer or infiltrating tumor.
Collapse
|
21
|
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.
Collapse
|
22
|
Kallidonis P, Kamal W, Panagopoulos V, Vasilas M, Amanatides L, Kyriazis I, Vrettos T, Fligou F, Liatsikos E. Thulium Laser in the Upper Urinary Tract: Does the Heat Generation in the Irrigation Fluid Pose a Risk? Evidence from an In Vivo Experimental Study. J Endourol 2016; 30:555-9. [DOI: 10.1089/end.2015.0768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Wissam Kamal
- Department of Urology, University of Patras, Patras, Greece
| | | | | | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | |
Collapse
|
23
|
Kallidonis P, Amanatides L, Panagopoulos V, Kyriazis I, Vrettos T, Fligou F, Kamal W, Liatsikos EN. Does the Heat Generation by the Thulium:Yttrium Aluminum Garnet Laser in the Irrigation Fluid Allow Its Use on the Upper Urinary Tract? An Experimental Study. J Endourol 2016; 30:422-7. [DOI: 10.1089/end.2015.0252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | | | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Wissam Kamal
- Department of Urology, University of Patras, Patras, Greece
| | | |
Collapse
|
24
|
Zhang XR, Feng C, Zhu WD, Si JM, Gu BJ, Guo H, Song LJ, Li C. Two Micrometer Continuous-Wave Thulium Laser Treating Primary Non-Muscle-Invasive Bladder Cancer: Is It Feasible? A Randomized Prospective Study. Photomed Laser Surg 2015; 33:517-23. [PMID: 26397029 DOI: 10.1089/pho.2015.3913] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xin-Ru Zhang
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Chao Feng
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Wei-Dong Zhu
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Jie-Min Si
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Bao-Jun Gu
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Hui Guo
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Lu-Jie Song
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| | - Chao Li
- Department of Urology, Shanghai Jiaotong University-Affiliated Shanghai Sixth People's Hospital, ShangHai, PR China
| |
Collapse
|
25
|
Hermann GG, Mogensen K, Lindvold LR, Haak CS, Haedersdal M. Office-based transurethral devascularisation of low grade non-invasive urothelial cancer using diode laser. A feasibility study. Lasers Surg Med 2015; 47:620-5. [PMID: 26373344 DOI: 10.1002/lsm.22402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Frequent recurrence of non-muscle invasive bladder tumours (NMIBC) requiring transurethral resection of bladder tumour (TUR-BT) and lifelong monitoring makes the lifetime cost per patient the highest of all cancers. A new method is proposed for the removal of low grade NMIBCs in an office-based setting, without the need for sedation and pain control and where the patient can leave immediately after treatment. STUDY DESIGN/PATIENTS AND METHODS An in vitro model was developed to examine the dose/response relationship between laser power, treatment time, and distance between laser fibre and target, using a 980 nm diode laser and chicken meat. The relationship between depth and extent of tissue destruction and the laser settings was measured using microscopy and non-parametric statistical analysis. A patient with low grade stage Ta tumour and multiple comorbidity, and therefore not fit for general anaesthesia, had a tumour devascularised using the laser at the tumour base, in the outpatient department. The tumour was left in the bladder. RESULTS In the in vitro model, depth of tissue destruction increased with laser illumination up to 30 seconds, where median depth was 4.1 mm. With longer illumination the tissue destruction levelled off. The width of tissue destruction was 2-3 mm independent of laser illumination time. The in vivo laser treatments devascularised the tumour, which was later shed from the mucosa and passed out with the urine in the days following treatment. Pain score was 0 on a visual log scale (0-10). The tumour had completely disappeared two weeks after treatment. CONCLUSION This diode laser technique may provide almost pain-free office-based treatment of low grade urothelial cancer using flexible cystoscopes in conscious patients. A prospective randomised study will be scheduled to compare the technique with standard TUR-BT in the operating theatre.
Collapse
Affiliation(s)
- Gregers G Hermann
- Department of Urology, Bispebjerg/Frederiksberg Hospital, Copenhagen University, Ndr. Fasan vej 57, DK-2000, Frederiksberg
| | - Karin Mogensen
- Department of Urology, Bispebjerg/Frederiksberg Hospital, Copenhagen University, Ndr. Fasan vej 57, DK-2000, Frederiksberg
| | - Lars R Lindvold
- Centre for Nuclear Technologies (Nutech), Technical University of Denmark (DTU), DK-4000 Roskilde, Denmark
| | - Christina S Haak
- Department of Dermatology, Bispebjerg Hospital, Copenhagen University, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, Copenhagen University, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| |
Collapse
|
26
|
Xu Y, Guan W, Chen W, Xie C, Ouyang Y, Wu Y, Liu C. Comparing the treatment outcomes of potassium-titanyl-phosphate laser vaporization and transurethral electroresection for primary nonmuscle-invasive bladder cancer: A prospective, randomized study. Lasers Surg Med 2015; 47:306-11. [PMID: 25864416 DOI: 10.1002/lsm.22342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Yansheng Xu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Weimin Guan
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Weihao Chen
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Changliang Xie
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Yun Ouyang
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Yiguang Wu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Cuilong Liu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| |
Collapse
|
27
|
Emiliani E, Herrmann TRW, Breda A. Thulium laser for the treatment of upper urinary tract carcinoma (UTUC)? Are we there, yet? World J Urol 2015; 33:595-7. [DOI: 10.1007/s00345-015-1511-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/09/2015] [Indexed: 02/02/2023] Open
|
28
|
Bach T, Muschter R, Herrmann TR, Knoll T, Scoffone CM, Laguna MP, Skolarikos A, Rischmann P, Janetschek G, De la Rosette JJ, Nagele U, Malavaud B, Breda A, Palou J, Bachmann A, Frede T, Geavlete P, Liatsikos E, Jichlinski P, Schwaibold HE, Chlosta P, Martov AG, Lapini A, Schmidbauer J, Djavan B, Stenzl A, Brausi M, Rassweiler JJ. Technical solutions to improve the management of non-muscle-invasive transitional cell carcinoma: summary of a European Association of Urology Section for Uro-Technology (ESUT) and Section for Uro-Oncology (ESOU) expert meeting and current and future pers. BJU Int 2014; 115:14-23. [DOI: 10.1111/bju.12664] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thorsten Bach
- Department of Urology; Asklepios Hospital Harburg; Hamburg Germany
| | - Rolf Muschter
- Department of Urology; Diakoniekrankenhaus Rotenburg; Rotenburg Germany
| | | | - Thomas Knoll
- Department of Urology; Klinikum Sindelfingen-Böblingen; Sindelfingen Germany
| | | | - M. Pilar Laguna
- Department of Urology; AMC University of Amsterdam; Amsterdam The Netherlands
| | - Andreas Skolarikos
- Second Department of Urology; Sismanoglio Hospital, Athens Medical School; Athens Greece
| | - Pascal Rischmann
- Department of Urology; Rangueil University Hospital; Toulouse France
| | - Günter Janetschek
- Department of Urology; Paracelsius Medical University; Salzburg Austria
| | | | - Udo Nagele
- Department of Urology; LKH Hall; Hall in Tirol Austria
| | - Bernard Malavaud
- Department of Urology; Rangueil University Hospital; Toulouse France
| | - Alberto Breda
- Department of Urology; Fundacio Puigvert; Autonoma University of Barcelona; Barcelona Spain
| | - Juan Palou
- Department of Urology; Fundacio Puigvert; Autonoma University of Barcelona; Barcelona Spain
| | | | - Thomas Frede
- Department of Urology; Helios Klinik Müllheim; Müllheim Germany
| | - Petrisor Geavlete
- Department of Urology; Saint John Emergency Clinical Hospital; Bucharest Romania
| | | | | | | | - Piotr Chlosta
- Department of Urology; Centre of Oncology; Kielce Poland
| | - Alexey G. Martov
- Department of Endourology; Municipal Clinical Hospital #57 of Moscow; Moscow Russian Federation
| | - Alberto Lapini
- Department of Urology; Careggi Hospital, University of Florence; Florence Italy
| | | | - Bob Djavan
- Department of Urology; Medical University of Vienna; Vienna Austria
| | - Arnulf Stenzl
- Department of Urology; University of Tübingen; Tübingen Germany
| | - Mauricio Brausi
- Department of Urology; New Estense S. Agostino Hospital Ausl Modena; Modena Italy
| | | |
Collapse
|
29
|
Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, Merseburger AS, Herrmann TRW. Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014. World J Urol 2014; 33:571-9. [PMID: 24935098 DOI: 10.1007/s00345-014-1337-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/30/2014] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Bladder cancer (BC) represents a growing health care problem worldwide. In times of tight budgets and an aging society, new strategies for the transurethral treatment of BC are needed. Laser devices used for tumor vaporization and/or en bloc resection provide an alternative to parvenu strategies. MATERIALS AND METHODS Medline/Cochrane search was performed using following terms: bladder cancer, urothelial carcinoma, laser, en bloc, vaporization, photoablation, holmium, thulium, Ho:YAG, Tm:YAG, HoLRBT and TmLRBT. Last date of search was February 12, 2014. RESULTS Eighteen publications in English were identified including 800 patients (Ho:YAG = 652 patients and Tm:YAG = 148 patients). Data on en bloc resection techniques were presented in 10 publications, 7 publications provided data of tumor vaporization and one publication presented data on both. Level of evidence based on SIGN is mainly 3 (non-analytic studies); only three studies are level 2 (prospective case control studies). Tumor vaporization seems to be a promising alternative for the treatment of recurrent tumors in selected patients. It can be performed in an office-based approach without the need of general anesthesia. The use of photodynamic diagnostic might enhance surgical quality. The principle of en bloc resection should provide accurate staging in most cases; however, data on this important aspect are missing. Peri- and postoperative complications are scarce. Due to the nature of the energy source, bladder perforation caused by obturator nerve reflex is highly unlikely when using lasers. There is a trend toward decreased infield recurrence rates. CONCLUSIONS Lasers are potentially useful alternatives to conventional TURBT, but systematical assessments using standardized classification systems and well-designed RCTs are needed to make results comparable.
Collapse
Affiliation(s)
- Mario W Kramer
- Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
30
|
He D, Fan J, Wu K, Wang X, Wu D, Li L, Li X, Liu L, Cao P, Cao J, Chang LS. Novel green-light KTP laser en bloc enucleation for nonmuscle-invasive bladder cancer: technique and initial clinical experience. J Endourol 2014; 28:975-9. [PMID: 24735433 DOI: 10.1089/end.2013.0740] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The standard procedure for staging and treating nonmuscle-invasive bladder cancer (NMIBC) is still transurethral resection of bladder tumor (TURBT) via a wire loop. However, TURBT is associated with serious disadvantages that facilitate tumor recurrence. Recently, lasers have been explored as treatment tools for bladder tumors. Here, we report a novel tumor en bloc enucleation using a front-firing green-light potassium-titanyl-phosphate laser and its initial clinical application. PATIENTS AND METHODS From March through June 2013, 45 patients with NMIBC received modified transurethral resection using a front-firing green-light laser. En bloc enucleation was performed on all tumors. Preoperative and intraoperative data were retrospectively collected. RESULTS All patients successfully went through a session of treatment with front-firing green-light laser enucleation of the bladder tumor. Complications such as bladder hemorrhage, vesicle perforation, and obturator nerve reflex were not encountered during the treatment. The tumor diameter ranges from 0.3 to 3.0 cm with a mean value of 1.8 cm. Mean operative time and enucleation time were 21 (12-38) and 12 (4-23) minutes, respectively. Serum hemoglobin decreased 1.1 (0.1-2.4) mg/dL averagely. Mean catheter time was 2.0 (1.0-3.0) days, and mean postoperative hospital stay was 2.5 (1.5-4.0) days. The stages of bladder cancer included 27 Ta, 15 T1, and 3 T2a. No tumor recurrence was observed at the initial 6-month follow-up. CONCLUSIONS The modified technique using a front-firing green-light laser to en bloc enucleate bladder tumors is effective and safe for treatment of NMIBC. Moreover, it may improve the accurate valuation of tumor stage and prediction of postoperative prognosis, although long-term outcomes and prospective clinical trials are needed.
Collapse
Affiliation(s)
- Dalin He
- 1 Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University , Xi'an, P.R. China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Muto G, Collura D, Giacobbe A, D'Urso L, Muto GL, Demarchi A, Coverlizza S, Castelli E. Thulium:yttrium-aluminum–garnet Laser for En Bloc Resection of Bladder Cancer: Clinical and Histopathologic Advantages. Urology 2014; 83:851-5. [DOI: 10.1016/j.urology.2013.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/29/2013] [Accepted: 12/13/2013] [Indexed: 11/30/2022]
|
32
|
Kramer MW, Abdelkawi IF, Wolters M, Bach T, Gross AJ, Nagele U, Conort P, Merseburger AS, Kuczyk MA, Herrmann TRW. Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer. MINIM INVASIV THER 2014; 23:206-13. [DOI: 10.3109/13645706.2014.880065] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
33
|
Liu H, Wu J, Xue S, Zhang Q, Ruan Y, Sun X, Xia S. Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer. J Int Med Res 2013; 41:984-92. [PMID: 23760914 DOI: 10.1177/0300060513477001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To compare the safety and efficacy of conventional monopolar transurethral resection of bladder tumour (TURBT) and 2-micron continuous-wave laser resection (2-µm laser) techniques in the management of multiple nonmuscle-invasive bladder cancer (NMIBC), and to investigate long-term effects on tumour recurrence. Methods Patients with multiple NMIBC were randomized to receive TURBT or 2-µm laser in a nonblinded manner. All patients received intravesical chemotherapy with epirubicin (40 mg/40 ml) for 8 weeks, beginning 1 week after surgery, followed with monthly maintenance therapy for 12 months. Three-year follow-up data of preoperative, operative and postoperative management were recorded. Results In total, 120 patients were included: 56 in the TURBT group and 64 in the 2-µm laser group. Intra- and postoperative complications (including bladder perforation, bleeding and irritation) were less frequently observed in the 2-µm laser group compared with the TURBT group. There were no significant differences in first time to recurrence, overall recurrence or occurrence of urethral strictures. Conclusions The 2-µm laser resection method was more effective than TURBT in reducing rates of intra- and postoperative complications, but offered no additional benefit regarding tumour recurrence.
Collapse
Affiliation(s)
- H Liu
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - J Wu
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - S Xue
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Q Zhang
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Y Ruan
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - X Sun
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - S Xia
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
34
|
Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. [European Association of Urology guidelines on laser technologies]. Actas Urol Esp 2013; 37:63-78. [PMID: 22989380 DOI: 10.1016/j.acuro.2012.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 12/14/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
Collapse
Affiliation(s)
- T R W Herrmann
- Departamento de Urología y Uro-oncología, Medical School of Hanover (MHH), Hanover, Alemania.
| | | | | | | | | |
Collapse
|
35
|
Kramer MW, Wolters M, Abdelkawi IF, Merseburger AS, Nagele U, Gross A, Bach T, Kuczyk MA, Herrmann TRW. [Transurethral en bloc resection of non-muscle invasive bladder cancer. What is the state of the art?]. Urologe A 2012; 51:798-804. [PMID: 22622487 DOI: 10.1007/s00120-012-2876-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bladder cancer of the urothelium is the second most common malignancy among urological tumors. In view of a worldwide aging population and the fact that increased incidence rates are associated with higher age, new socioeconomic challenges will appear. Even nowadays the treatment of bladder cancer bears the highest lifetime treatment costs per patient among all forms of cancer. In conjunction with higher comorbidity rates among older patients urologists are facing new challenges in the treatment and care of patients with bladder cancer. The standard treatment for non-muscle invasive bladder cancer (NMIBC) is monopolar transurethral resection using resection loops (TURB). Based on experience in the surgical treatment of benign prostatic hyperplasia, different concepts of en bloc resection of bladder tumors using alternative energy resources (e.g. holmium laser, thulium laser and the water-jet HybridKnife) have been developed. Goals of new treatment modalities are reduction of perioperative and postoperative comorbidities, better pathological work-up of the specimens and increased recurrence-free survival. Postulated advantages using laser devices are a more precise cutting line as well as better hemostasis. The evidential value of this review is limited due to the lack of randomized, prospective studies. However, there is a tendency towards a limitation of perioperative and postoperative morbidities as well as higher chance of well-preserved tissues for better pathohistological evaluation using en bloc resection methods. More studies with long-term follow-up periods and better randomization are needed to clarify whether en bloc strategies provide better long-term oncological survival.
Collapse
Affiliation(s)
- M W Kramer
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Hannover
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. EAU guidelines on laser technologies. Eur Urol 2012; 61:783-95. [PMID: 22285403 DOI: 10.1016/j.eururo.2012.01.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
Collapse
Affiliation(s)
- Thomas R W Herrmann
- Department of Urology and Urooncology, Medical School of Hanover [MHH], Hanover, Germany.
| | | | | | | | | | | |
Collapse
|
37
|
Liu H, Xue S, Ruan Y, Sun X, Han B, Xia S. 2-micrometer continuous wave laser treatment for multiple non-muscle-invasive bladder cancer with intravesical instillation of epirubicin. Lasers Surg Med 2011; 43:15-20. [PMID: 21254138 DOI: 10.1002/lsm.21014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES We have reported the efficacy and safety of 2-micrometer continuous wave laser resection of non-muscle-invasive bladder tumor (NMIVBC) (World J Urology 2010;28:157-161). In this study, we evaluated the use of 2-micrometer continuous wave laser resection in combination with intravesical instillation of epirubicin for the treatment of multiple NMIVBC. MATERIALS AND METHODS From September 2007 to April 2008, sixty patients with multiple NMIVBC were included in this study (44 cases of low grade papillary urothelial carcinoma, 10 cases of high grade papillary urothelial carcinoma, and six cases of papillary urothelial neoplasm with low malignant potential). Imaging examinations including pelvic computer tomography (CT) and intravenous urography showed no extravesical extension, lymphatic metastasis or any lesions of upper urinary tract. All patients received 2-micrometer continuous wave laser therapy under continuous epidural anesthesia, and intravesical chemotherapy with epirubicin 1 week later (intravesical instillation weekly for 8 weeks, followed by monthly maintenance to 12 months). RESULTS Totally 211 tumors in 60 patients were successfully removed with 2-micrometer continuous wave laser. The mean operation time was 48 minutes per patient (ranged 20-90 minutes) and 13.6 minutes per tumor (range 5-25 minutes). No obturator nerve reflection or bladder perforation occurred during the procedure. All patients finished 12 months of intravesical chemotherapy without severe complications. The mean followed-up time was 23 months. Tumor recurrences were found in 13 patients (22%). CONCLUSIONS The combination of 2-micrometer continuous wave laser and intravesical chemotherapy is feasible, safe, and efficacious for the treatment of multiple NMIVBC.
Collapse
Affiliation(s)
- Haitao Liu
- The First People's Hospital Affiliated to Shanghai Jiao Tong University, University Department of Urology, Shanghai, China
| | | | | | | | | | | |
Collapse
|
38
|
Kramer MW, Bach T, Wolters M, Imkamp F, Gross AJ, Kuczyk MA, Merseburger AS, Herrmann TRW. Current evidence for transurethral laser therapy of non-muscle invasive bladder cancer. World J Urol 2011; 29:433-42. [PMID: 21544662 DOI: 10.1007/s00345-011-0680-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 04/11/2011] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Bladder cancer is the second most common malignancy of urologic tumors. Back in 1976, lasers were added to the endourological armetarium for bladder tumor treatment. Despite nowadays' standard procedure for staging and treating non-muscle invasive bladder tumor by transurethral resection of bladder tumors (TURB) via a wire loop, laser resection techniques for bladder tumor came back in focus with the introduction of Ho:YAG and not to mention recently Tm:YAG lasers. This review aims to display the current evidence for these techniques. MATERIALS AND METHODS Throughout April 2010, MEDLINE and the Cochrane central register of controlled trials were searched previously for the following terms: "Laser, resection, ablation, coagulation, Nd:YAG Neodym, HoYAG: Holmium, Tm:YAG Thulium and transitional carcinoma, bladder, intravesical." RESULTS Eleven articles on Ho:YAG and 7 on Tm:YAG were identified. Searches by Cochrane online library resulted in no available manuscripts. CONCLUSION Today, Nd:YAG does not play any role in treatment of lower urinary tract transitional cell carcinoma. Ho:YAG and Tm:YAG seem to offer alternatives in the treatment of bladder cancer, but still to prove their potential in larger prospective randomized controlled studies with long-term follow-up. Future expectations will show whether en bloc resection of tumors are preferable to the traditional "incise and scatter" resection technique, in which is contrary to all oncological surgical principles. For the primary targets, here are within first-time clearance of disease, in addition to low in-fields and out-of-fields recurrence rates.
Collapse
Affiliation(s)
- Mario W Kramer
- Department of Urology and Urologic Oncology, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30165, Hannover, Germany
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Bladder cancer is the 5th commonest cancer in the UK and up to 85% will present with superficial disease. Considering the principals of oncological surgery, best practice is to excise a tumour whole with clear circumferential margins. The inherent flaw of transurethral resection (TUR) is tumour fragmentation. However, high quality resection and immediate single-dose chemotherapy decreases recurrence rates and disease progression for superficial disease. TUR is the current gold standard for diagnosis and treatment of superficial bladder cancer. The associated morbidity is usually low. Good quality TUR can be difficult with tumours in diverticula, over ureteric orifices, on the dome/anterior/posterior wall or if obturator nerve stimulation occurs. As such technical tips are provided. Modern TUR relies on white light. The use of fluorescence cystoscopy will almost certainly increase, challenging white light TUR as the current gold standard. Furthermore, the development of bladder cancer urinary markers may provide a cost effective and non-invasive means of determining the frequency of surveillance cystoscopy.
Collapse
|
40
|
Dray X, Donatelli G, Krishnamurty DM, Dubcenco E, Wroblewski RJ, Assumpcao L, Giday SA, Buscaglia JM, Shin EJ, Magno P, Pipitone LJ, Marohn MR, Kantsevoy SV, Kalloo AN. A 2-microm continuous-wave laser system for safe and high-precision dissection during NOTES procedures. Dig Dis Sci 2010; 55:2463-70. [PMID: 20704034 DOI: 10.1007/s10620-010-1214-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Lasers 2-microm in wavelength offer efficient tissue cutting with limited thermal damage in biological tissue. OBJECTIVE To evaluate the dissection capabilities of a 2-microm continuous-wave laser for NOTES procedures. METHODS AND PROCEDURES We conducted 18 acute animal experiments. Group 1 (three animals): transcolonic access to the peritoneal cavity (15-W transcolonic laser puncture, balloon dilation over the laser probe). Group 2 (six animals): transcolonic access with needle-knife puncture and balloon dilation. Group 3 (three animals): transgastric access to the peritoneal cavity (similar technique as group 1) followed by laser-assisted dissection of the kidney. In one animal of group 3, a therapeutic target (hematoma) was created by percutaneous puncture of the kidney. Group 4 (six animals): transgastric access (similar to the technique of group 2). RESULTS Translumenal access to the peritoneal cavity was achieved in 2-3 min in group 1 (significantly shorter than with the needle-knife-assisted technique, 4-5 min, p=0.02) and in 7-10 min in group 3 (compared to 6-17 min in group 4, p=0.88). In group 3, laser dissection of the parietal peritoneum and of perinephric connective tissue allowed access to the retroperitoneum with complete removal of a blood collection in the animal with puncture trauma. Laser dissection demonstrated good maneuverability, clean and rapid cutting, and excellent hemostasis. Peritoneoscopy and necropsy showed no damage of targeted tissue and surrounding organs. CONCLUSIONS The 2-microm continuous-wave laser system showed promising capabilities for highly precise and safe dissection during NOTES procedures.
Collapse
Affiliation(s)
- Xavier Dray
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Zhong C, Guo S, Tang Y, Xia S. Clinical observation on 2 micron laser for non-muscle-invasive bladder tumor treatment: single-center experience. World J Urol 2010; 28:157-61. [DOI: 10.1007/s00345-010-0532-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 02/13/2010] [Indexed: 11/29/2022] Open
|