En Bloc Resection Of Bladder Tumors Research Articles

Experts' recommendations in laser use for the treatment of bladder cancer: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training and Research in Urological Surgery and Technology (TRUST)-Group.

To identify laser settings and limits applied by experts during laser vaporization (vapBT) and laser en-bloc resection of bladder tumors (ERBT) and to identify preventive measures to reduce complications. After a focused literature search to identify relevant questions, we conducted a survey (57 questions) which was sent to laser experts. The expert selection was based on clinical experience and scientific contribution. Participants were asked for used laser types, typical laser settings during specific scenarios, and preventive measures applied during surgery. Settings for a maximum of 2 different lasers for each scenario were possible. Responses and settings were compared among the reported laser types. Twenty-three of 29 (79.3%) invited experts completed the survey. Thulium fiber laser (TFL) is the most common laser (57%), followed by Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) (48%), continuous wave (cw) Thulium:Yttrium-Aluminium-Garnet (Tm:YAG) (26%), and pulsed Tm:YAG (13%). Experts prefer ERBT (91.3%) to vapBT (8.7%); however, relevant limitations such as tumor size, number, and anatomical tumor location exist. Laser settings were generally comparable; however, we could find significant differences between the laser sources for lateral wall ERBT (p = 0.028) and standard ERBT (p = 0.033), with cwTm:YAG and pulsed Tm:YAG being operated in higher power modes when compared to TFL and Ho:YAG. Experts prefer long pulse modes for Ho:YAG and short pulse modes for TFL lasers. TFL seems to have replaced Ho:YAG and Tm:YAG. Most laser settings do not differ significantly among laser sources. For experts, continuous flow irrigation is the most commonly applied measure to reduce complications.

Transurethral Resection of Bladder Tumor: Novel Techniques in a New Era.

Transurethral resection of bladder tumor (TURBT) serves both diagnostic and therapeutic purposes in the management of bladder cancer. Attaining a high-quality TURBT is not always guaranteed due to various factors. En-bloc resection of bladder tumors (ERBT) holds promise to be a primary technique for removing bladder tumors in most non-muscle invasive bladder cancers. However, so far, no conclusive evidence indicates the superiority of any specific energy source used for ERBT. While laser energy can prevent the activation of obturator nerve reflex during ERBT, it poses challenges such as thermal injury and imprecise controllability. Needle-shaped electrodes offer high-level precision and controllability, without causing tissue deterioration or vaporization. The primary limitation of ERBT at present is the extraction/harvesting of large en-bloc specimens. Effective tools have been developed to overcome this limitation. Enhanced cystoscopy improves the detection of flat and small bladder tumors, allowing for better removal of cancerous tissues and significantly reducing recurrence rates. Advances in medical technology have brought forth a multitude of strategies to address the shortcomings of traditional TURBT. Appliances with large operating channel provide a platform for conducting laparoscopic procedures within the context of pneumocystoscopy, facilitating the execution of super TURBT and conferring comparable advantages to en-bloc resection. Moreover, the utilization of pneumocystoscopy enables the safe and effective performance of transurethral partial cystectomy for localized muscle-invasive bladder cancer. Novel techniques significantly improve the precision of the transurethral surgery and lower the risk of complications.

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

BackgroundTrans-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.ObjectivesAssessment 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.MethodsThis 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.ResultsThe 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.ConclusionTmL-ERBT is safe and feasible for complete resection of NMIBC with a short learning curve and adequate cancer control.

Feasibility of Novel Technique of Flexible Cystoscopic En Bloc Snare Resection of Bladder Tumor: f-ESRBT.

Background: En bloc resection of bladder tumors (ERBT) has been used as a treatment option to improve pathologic diagnostic accuracy in non-muscle invasive bladder cancer. We report on the feasibility of a novel ERBT technique using an electrosurgical snare with flexible cystoscope: flexible cystoscopic En bloc Snare Resection of Bladder Tumor (f-ESRBT). Methods: We used the electrosurgical snare to resect a superficial bladder tumor after injection of 50% glucose in the submucosa at the tumor base. We collected each resected tumor with a basket catheter and coagulated the resected area with a coagulation electrode. A flexible cystoscope was used for all procedures. Results/Discussion: We performed 10 operations. Mean tumor size was 10.2 ± 7.3 mm and mean surgery time was 13.8 ± 6.8 minutes. All procedures were performed without complications. Results showed f-ESRBT to be simple and minimally invasive and to enable accurate pathologic diagnoses. Conclusion: f-ESRBT is a feasible treatment option for small and non-muscle invasive bladder cancer.

En Bloc Resection Versus Conventional TURBT for T1HG Bladder Cancer: A Propensity Score-Matched Analysis

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. 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. 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. 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.

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

IntroductionThe Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures.Materials and MethodsWe conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis.ResultsIn terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT.ConclusionTFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.

En bloc resection for nonmuscle-invasive bladder cancer: selecting a proper laser.

To discuss the most recent surgical lasers that have been made available to us and to evaluate their potential in performing en bloc resection of nonmuscle invasive bladder cancer. Laser en bloc resection of bladder tumors (ERBT) can be performed with a number of laser systems including Ho:YAG, GreenLight, diode, Tm:YAG and thulium fiber lasers (TFL). The data that is currently available suggests that the water-targeting devices (utilizing water as a primary chromophore - Ho:YAG, Tm:YAG, TFL) may have a number of advantages over hemoglobin-targeting systems (potassium titanyl phosphate:YAG, lithium triborate:YAG). One recent addition to the surgical armamentarium Moses effect enhanced Ho:YAG and the TFL (being able to work both in quasi-continuous and SuperPulsed modes) necessitates careful discussion and comparison with the other available devices. The majority of available lasers have proven to be safe to use and compared to electrocautery allow for lower rates of obturator nerve reflex and result in fewer bleeding complications. The minimal penetration depth and decreased peak power of Tm:YAG and TFLs render them the devices of choice when it comes to ERBT. Unfortunately, more studies on ERBT with TFL are needed in order for us to make a sound assessment of the respective pros and cons.

MP16-04 LASER VERSUS ELECTRICAL E-BLOC RESECTION OF BLADDER TUMORS FOR TREATMENT OF NON-MUSCLE INVASIVE BLADDER CANCER; CRITICAL APPRAISAL THROUGH A RANDOMIZED TRIAL

You have accessJournal of UrologyBladder Cancer: Non-invasive II (MP16)1 Sep 2021MP16-04 LASER VERSUS ELECTRICAL E-BLOC RESECTION OF BLADDER TUMORS FOR TREATMENT OF NON-MUSCLE INVASIVE BLADDER CANCER; CRITICAL APPRAISAL THROUGH A RANDOMIZED TRIAL Ahmed Elshal, Mohamed Bahy, Mahmoud Laymon, Abdelwahab Hashem, Ahmed Mosbah, and Adel Nabeeh Ahmed ElshalAhmed Elshal More articles by this author , Mohamed BahyMohamed Bahy More articles by this author , Mahmoud LaymonMahmoud Laymon More articles by this author , Abdelwahab HashemAbdelwahab Hashem More articles by this author , Ahmed MosbahAhmed Mosbah More articles by this author , and Adel NabeehAdel Nabeeh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002001.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Laser En-bloc resection of bladder tumors (ERBT) has been reported as a safer procedure with less residual tumor and better specimen quality when compared to conventional resection. In this trial, we tested the non-inferiority of electrical versus laser ERBT invasive bladder cancer (NMIBC) METHODS: Between June 2019 and December 2020, 106 patients with cystoscpic visual criteria of NMIBC were randomly allocated to laser and electrical enbloc resection. The primary endpoint was to assess the need of conversion to conventional TURBT. Operative parameters, quality of specimen, perioperative complications and completeness of resection as indicated by residual tumors in restaging TUR (2-6 weeks after ERBT) Trial ID NCT04029948 RESULTS: Patients` and tumor`s baseline characteristics were comparable in both groups. More resection time was reported during laser ERBT, p= 0.04. Technical failure with conversion to conventional resection was in 2 cases during electrical ERBT and none during Laser ERBT, P=0.146 Detrusor muscle was sampled in 59.3% and 53.8% (p=0.574) in Laser ERBT and electrical ERBT, respectively. Lamina propria invasion was 85.1%% and 84% in Laser ERBT and electrical ERBT, respectively (p=0.111). Intraoperative complications were reported in 17.3% after electrical ERBT in the form of obturator kick, bladder perforation and with no complications reported in the laser group (p=0.002). Table 1 There was no statistical difference between laser and electrosurgical ERBT regarding urethral catheter duration and hospital stay with p value 0.2 & 0.9 in the 2 groups respectively. Residual tumors at second look were detected in 6.5% and 2.6% Laser ERBT and electrical ERBT, respectively (p=0.391). CONCLUSIONS: Laser ERBT seems to be safer procedure for bladder tumor resection with longer resection time when compared to electrical ERBT. Source of Funding: no © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e297-e297 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Elshal More articles by this author Mohamed Bahy More articles by this author Mahmoud Laymon More articles by this author Abdelwahab Hashem More articles by this author Ahmed Mosbah More articles by this author Adel Nabeeh More articles by this author Expand All Advertisement Loading ...

A survey-based study on the spread of en-bloc resection of bladder tumors among IEA and ESUT members.

A survey-based study on the spread of en-bloc resection of bladder tumors among IEA and ESUT members.

P0758 - Laser versus Electrical En-Bloc resection of bladder tumors for treatment of non-muscle invasive bladder cancer; critical appraisal through a randomized trial

P0758 - Laser versus Electrical En-Bloc resection of bladder tumors for treatment of non-muscle invasive bladder cancer; critical appraisal through a randomized trial

En Bloc Resection of Bladder Tumor-Is It the Way Forward?

Transurethral resection of bladder tumors (TURBT) represents the cornerstone in diagnosis and treatment of bladder cancer but recurrence is observed in up to 80% and over- or understaging with TURBT is common. A more recent development to overcome these limitations represents en-bloc resection of bladder tumors (ERBT) which offers several advantages over TURBT. In this report, we briefly review studies assessing outcomes of bladder cancer patients undergoing ERBT. Most randomized and non-randomized trial demonstrate improvement in clinical outcomes for ERBT over TURBT, however more pathological and translational studies are warranted.

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.

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. 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). 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 ≥ 3cm and pT1c were significantly associated with shorter PFS. On multivariate analysis, only pT1c was independently associated with shorter PFS. 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.

MP73-17 THULIUM LASER EN-BLOC RESECTION OF BLADDER TUMOR (THUEB-BT): TIGER (THULIUM ITALIAN GROUP ESTABLISHED ON RESEARCH) STUDY TO COMPARE LASER AND ELECTRICAL EN- BLOC TRANSURETHRAL RESECTION OF BLADDER TUMOR

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP73)1 Apr 2020MP73-17 THULIUM LASER EN-BLOC RESECTION OF BLADDER TUMOR (THUEB-BT): TIGER (THULIUM ITALIAN GROUP ESTABLISHED ON RESEARCH) STUDY TO COMPARE LASER AND ELECTRICAL EN- BLOC TRANSURETHRAL RESECTION OF BLADDER TUMOR Raffaele Inzillo*, Giorgio Bozzini, Maruccia Serena, Antonio Luigi Pastore, Besana Umberto, Marco Amato, Luigi Bevilacqua, Paolo Parma, Giovanni Saredi, Stefano Casellato, Salvatore Micali, Bernardo Rocco, and Carlo Buizza Raffaele Inzillo*Raffaele Inzillo* More articles by this author , Giorgio BozziniGiorgio Bozzini More articles by this author , Maruccia SerenaMaruccia Serena More articles by this author , Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Besana UmbertoBesana Umberto More articles by this author , Marco AmatoMarco Amato More articles by this author , Luigi BevilacquaLuigi Bevilacqua More articles by this author , Paolo ParmaPaolo Parma More articles by this author , Giovanni SarediGiovanni Saredi More articles by this author , Stefano CasellatoStefano Casellato More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , and Carlo BuizzaCarlo Buizza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000959.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: En bloc resection of bladder tumors (EBRBT) may improve staging quality and perioperative morbidity and influence tumor recurrence. We want to evaluate the safety, efficacy, and recurrence rates of electrical versus Thulium laser en bloc resection of bladder tumors (THUEB-BT). METHODS: This Italian multicenter study included 362 patients at four tertiary centers in Lombardia. TUR-BT was performed with monopolar/bipolar current or Thulium laser energy. Staging quality measured by detrusor muscle involvement, tumor size, switch to conventional TURBT rate, early postoperative outcomes, hemoglobin loss and 18-month follow-up data were analyzed. RESULTS: Electrical EBRBT and THUEB-BT resection were used to treat 178 and 184 patients, respectively. Median tumor size was 1.9 cm; largest tumor was 4.4 cm. Detrusor muscle was present in 89.4%. A switch to conventional TURBT was significantly more frequent in the electrical en-bloc group (23.7 vs. 3.7%, p <0.05). Mean operation time, postoperative irrigation, catheterization time, and hospitalization were not different from a statistical point of view. Overall complication rate was low (Clavien ≥ 3, 3.3%). Post-operative hemoglobin values were significantly lower after electrical ERBT (p = 0.0013). Patient’s mean follow up was 20.3 months; 72 (19.8%) had recurrences. In total, 72.2% recurrences occurred outside the ERBT resection field, mainly for THUEB-BT. CONCLUSIONS: ERBT is safe and reliable regardless of the energy source and provides high-quality resections of tumors > 1 cm. Recurrence rates did not differ between groups, and the majority of recurrences occurred outside the ERBT resection field, mainly in THUEB-BT group. Source of Funding: No © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1128-e1128 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raffaele Inzillo* More articles by this author Giorgio Bozzini More articles by this author Maruccia Serena More articles by this author Antonio Luigi Pastore More articles by this author Besana Umberto More articles by this author Marco Amato More articles by this author Luigi Bevilacqua More articles by this author Paolo Parma More articles by this author Giovanni Saredi More articles by this author Stefano Casellato More articles by this author Salvatore Micali More articles by this author Bernardo Rocco More articles by this author Carlo Buizza More articles by this author Expand All Advertisement PDF downloadLoading ...

Technical Considerations for Bipolar Enbloc Resection of Bladder Tumors

Abstract Introduction: Transurethral resection of bladder tumor (TURBT) is important for treatment, staging, and prognostication of bladder cancer. Conventional TURBT comprises piecemeal resection ...

En-bloc resection of bladder tumors for pathological staging: the value of lateral margins analysis.

In endoscopic resection of colorectal tumors, the pathological assessment of the lateral margins is a strong predictor of tumor recurrence after resection. The aim of the current study is to evaluate the value of the peritumoral margins assessment in ERBT on tumor recurrence. We retrospectively analyzed the data of 50 consecutive patients with NMIBC and treated by ERBT between January and December 2017. The lateral margins showed dysplasia in 16 patients and malignancy in three patients. Local recurrence occurred in 14 (28%) patients. It was noted that 57% of patients with recurrence showed some degree of dysplasia or malignancy in the lateral margin; however, on multivariate logistic regression lateral margins lesions were not significantly associated with recurrence (OR 2.175, 95% CI: 0.430-10.996, P=0.35). ERBT may improve the pathological report of bladder tumor. There was a trend toward increased rate of recurrence in patients with dysplasia or malignancy in their lateral margins; however, this was not statistically significant on multivariate analysis. Further studies with larger sample sizes are required to assess the value of lateral margin analysis.

The value of transurethral thulium laser en bloc resection combined with a single immediate postoperative intravesical instillation of pirarubicin in primary non-muscle-invasive bladder cancer.

The objective of this study was to evaluate which patients might benefit from a single immediate postoperative intravesical instillation (SII) compared to maintenance intravesical instillations (MII) in primary non-muscle-invasive bladder cancer (NMIBC) after transurethral en bloc resection of bladder tumors (ERBT). A total of 141 patients with primary NMIBC who underwent ERBT with thulium laser between January 2012 and May 2016 were retrospectively enrolled. All the patients were categorized into two groups based on the duration of postoperative intravesical instillation of pirarubicin (THP): single intravesical instillation (SII) group, patients received a single immediate postoperative intravesical instillation of THP (30mg), and maintenance intravesical instillations (MII) group, patients received a 1-year MII of THP (30mg). Prognosis and recurrence data of each group were analyzed. One hundred and four (73.8%) patients received MII, and other 37 (26.2%) patients received SII. There was no significant difference in recurrence-free survival (RFS) between the two groups (P = 0.105). Following recurrence risk-stratified analysis, patients with high recurrence risk who accepted SII had a significantly lower RFS rate than those who received MII (P = 0.027). However, there were no significant differences in RFS rate between the two groups in patients with low and intermediate recurrence risk. In the multivariate analysis, the number of tumors was found to be an independent prognostic factor for RFS in NMIBC patients [hazard ratio, 5.665; 95% confidence interval (CI), 2.577-12.454; P < 0.001]. SII seems not to be inferior to MII in patients with initial low-risk and intermediate-risk NMIBC after ERBT.

MP83-06 THULIUM FIBER LASER EN BLOC RESECTION OF BLADDER CANCER.

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2018MP83-06 THULIUM FIBER LASER EN BLOC RESECTION OF BLADDER CANCER. Alim Dymov, Leonid Rapoport, Andrey Vinarov, Dmitry Enikeev, Nikolay Sorokin, Roman Sukhanov, Dmitry Kislyakov, Alexandra Proskura, Akhmed Damiev, and Gregory Gololobov Alim DymovAlim Dymov More articles by this author , Leonid RapoportLeonid Rapoport More articles by this author , Andrey VinarovAndrey Vinarov More articles by this author , Dmitry EnikeevDmitry Enikeev More articles by this author , Nikolay SorokinNikolay Sorokin More articles by this author , Roman SukhanovRoman Sukhanov More articles by this author , Dmitry KislyakovDmitry Kislyakov More articles by this author , Alexandra ProskuraAlexandra Proskura More articles by this author , Akhmed DamievAkhmed Damiev More articles by this author , and Gregory GololobovGregory Gololobov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2754AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date en bloc resection of non-muscle-invasive bladder cancer (NMIBC) is regarded by urologists as a promising surgical option. Previous studies have shown that en bloc resection of bladder tumors (ERBT) provides a high quality specimen with a muscle layer in 96-100% of cases, while conventional transurethral resection of bladder tumors (cTURB) in only 50-86% of cases. Different energy sources can be used for ERBT (electrocautery, laser, cyber-knife). Laser energy seems to be preferable due to absence of obturator nerve reflex and very precise resection. This study aims to evaluate the feasibility, safety and efficacy of thulium fiber laser en bloc resection of NMIBC. METHODS 71 laser en bloc resections for NMIBC with thulium fiber laser (Urolase, IRE Polus, Russia) were performed from 2015 to 2016. The mean tumor size was 2.28±0.15 cm. The mean tumor number was 1,72±0.18. Tumors location: lateral bladder wall – 43%; close to ureteral orifice – 25.4%; bladder neck – 4.2%; posterior bladder wall – 19,7%; anterior bladder wall – 4.2%; bladder triangle – 3.5%. The laser settings were as follows: 1J, 10Hz, 10W. Rigid 24Ch/26Ch resectoscope and flexible cystoscope with 600 and 400 μm laser fibers were used. Operating time, specimen quality, intra- and postoperative complications (obturator nerve reflex, bladder wall perforation, bleeding), recurrence rate at 6, 12,18 months postop were evaluated. RESULTS The average operating time was 38,7±1.87 min (10 – 80 min). Detrusor muscle was present in 91.55% of specimens. However, detrusor tissue was absent only in the specimens after a couple of first procedures. No obturator nerve reflex, bladder wall perforation or significant bleeding were observed. Early mitomycin C instillation in all cases was done. Recurrence rates at 6, 12, 18 months postoperatively were 9.86%, 11.27% and 2.81%, respectively. CONCLUSIONS Thulium laser en bloc resection of bladder cancer is a safe and effective procedure for NMIBC treatment. Apparently, it gives acceptable recurrence and low complication rates providing high quality specimen for proper staging and decision-making on further management strategy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1117-e1118 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Alim Dymov More articles by this author Leonid Rapoport More articles by this author Andrey Vinarov More articles by this author Dmitry Enikeev More articles by this author Nikolay Sorokin More articles by this author Roman Sukhanov More articles by this author Dmitry Kislyakov More articles by this author Alexandra Proskura More articles by this author Akhmed Damiev More articles by this author Gregory Gololobov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mid-Term Follow-Up of “En Bloc” Resection of Nonmuscle Invasive Bladder Cancer: Results from a Prospective Single-Center Study

Abstract Introduction and Purpose: “En bloc” resection of bladder tumors (ERBTs) is an innovative technique, which is shown to improve staging quality and reduce recurrence at early follow-ups. Out...

MP26-04 SAFETY, EFFICACY AND 12-MONTHS RECURRENCE RATE OF LASER VS. ELECTRICAL EN BLOC RESECTION OF UROTHELIUM CARCINOMA OF THE BLADDER: RESULTS OF THE EBRUC TRIAL

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2015MP26-04 SAFETY, EFFICACY AND 12-MONTHS RECURRENCE RATE OF LASER VS. ELECTRICAL EN BLOC RESECTION OF UROTHELIUM CARCINOMA OF THE BLADDER: RESULTS OF THE EBRUC TRIAL Mario W. Kramer, Jens J. Rassweiler, Jan Klein, Alexey Martov, Nikolay Baykov, Rodolfo Hurle, Guenter Janetschek, Lukas Lusuardi, Mathias Wolters, Mahmoud Abbas, Armin Leitenberger, Markus Riedl, Udo Nagele, Axel S. Merseburger, Markus A. Kuczyk, Marko Babjuk, and Thomas R.W. Herrmann Mario W. KramerMario W. Kramer More articles by this author , Jens J. RassweilerJens J. Rassweiler More articles by this author , Jan KleinJan Klein More articles by this author , Alexey MartovAlexey Martov More articles by this author , Nikolay BaykovNikolay Baykov More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Guenter JanetschekGuenter Janetschek More articles by this author , Lukas LusuardiLukas Lusuardi More articles by this author , Mathias WoltersMathias Wolters More articles by this author , Mahmoud AbbasMahmoud Abbas More articles by this author , Armin LeitenbergerArmin Leitenberger More articles by this author , Markus RiedlMarkus Riedl More articles by this author , Udo NageleUdo Nagele More articles by this author , Axel S. MerseburgerAxel S. Merseburger More articles by this author , Markus A. KuczykMarkus A. Kuczyk More articles by this author , Marko BabjukMarko Babjuk More articles by this author , and Thomas R.W. HerrmannThomas R.W. Herrmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1126AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The quality of transurethral resection of bladder tumors strongly determines patient's tumor after-care and prognosis. En bloc resection of bladder tumors (ERBT) might improve staging quality, perioperative morbidity and influence tumor recurrence. This is the first European multi-center study which was initiated by ESUT and was conducted to evaluate the safety, efficacy and recurrence rates of electrical vs. laser ERBT. METHODS Transurethral ERBT was performed on 221 prospectively collected patients in six academic centers with either monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative/surgical parameters and 12 months follow-up data were analyzed. RESULTS 156 and 65 patients were treated with electrical and laser ERBT, respectively. Median tumor size was 2.1 cm with biggest up to 5 cm. Detrusor muscle was available in 97.3%. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3% vs. 1.5%, p<0.001). Median operation duration (25 min), postoperative irrigation (1 day) and catheterization time (2 days) as well as hospitalization (3 days) were similar in both groups. Overall complication rate was low (Clavien ≥3, n=6 (2.7%)). Hemoglobin was significantly more decreased after electrical ERBT (p=0.0013), however overall hemoglobin loss was not clinically relevant (0.38 g/dl). 148 patients with first diagnosis of urothelium carcinoma of the bladder were followed for 12 months of which 33 (22.3%) recurred. 63.6% of recurrences occurred out of the ERBT resection field. No difference was noticed between both ERBT groups. CONCLUSIONS ERBT is safe and reliable regardless of the energy source used and offers high quality resections of tumors >1 cm. Recurrence rates did not differ within both groups although the majority of recurrences were noticed out of the ERBT resection field. Laser device might be an alternative for the treatment of patients with higher risk of postoperative bleeding due to its efficient hemostatic effect. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e294 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mario W. Kramer More articles by this author Jens J. Rassweiler More articles by this author Jan Klein More articles by this author Alexey Martov More articles by this author Nikolay Baykov More articles by this author Rodolfo Hurle More articles by this author Guenter Janetschek More articles by this author Lukas Lusuardi More articles by this author Mathias Wolters More articles by this author Mahmoud Abbas More articles by this author Armin Leitenberger More articles by this author Markus Riedl More articles by this author Udo Nagele More articles by this author Axel S. Merseburger More articles by this author Markus A. Kuczyk More articles by this author Marko Babjuk More articles by this author Thomas R.W. Herrmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laser versus electrical en bloc resection of bladder tumors: Results of a European multicenter study (EBRUC).

310 Background: The quality of transurethral resection of bladder tumors strongly determines patient’s tumor after-care and prognosis. En bloc resection of bladder tumors (ERBT) might improve staging quality, perioperative morbidity and influence tumor recurrence. This is the first European multi-center study which was initiated by ESUT and was conducted to evaluate the safety, efficacy and recurrence rates of electrical vs. laser ERBT. Methods: Transurethral ERBT was performed on 221 prospectively collected patients in six academic centers with either monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative/surgical parameters and 12 months follow-up data were analyzed. Results: 156 and 65 patients were treated with electrical and laser ERBT, respectively. Median tumor size was 2.1 cm with biggest up to 5 cm. Detrusor muscle was available in 97.3%. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3% vs. 1.5%, p&lt;0.001). Median operation duration (25 min), postoperative irrigation (1 day) and catheterization time (2 days) as well as hospitalization (3 days) were similar in both groups. Overall complication rate was low (Clavien ≥3, n=6 (2.7%)). Hemoglobin was significantly more decreased after electrical ERBT (p=0.0013), however overall hemoglobin loss was not clinically relevant (0.38 g/dl). 148 patients with first diagnosis of urothelium carcinoma of the bladder were followed for 12 months of which 33 (22.3%) recurred. 63.6% of recurrences occurred out of the ERBT resection field. No difference was noticed between both ERBT groups. Conclusions: ERBT is safe and reliable regardless of the energy source used and offers high quality resections of tumors &gt;1 cm. Recurrence rates did not differ within both groups although the majority of recurrences were noticed out of the ERBT resection field. Laser device might be an alternative for the treatment of patients with higher risk of postoperative bleeding due to its efficient hemostatic effect.