Transurethral Resection Of Bladder Tumor Group Research Articles

Use of in vivo Raman spectroscopy and cryoablation for diagnosis and treatment of bladder cancer

Transurethral resection of bladder tumor (TURBT) is the first-line treatment option for non-muscle invasive bladder cancer (NMIBC), but residual tumor often remains after TURBT, thereby leading to cancer recurrence. Here, we introduce combined use of in vivo Raman spectroscopy and in vivo cryoablation as a new approach to detect and remove residual bladder tumor during TURBT. Bladder cancer (BCa) patients treated with TURBT at our urological department between Dec 2019 and Jan 2021 were collected. First, Raman signals were collected from 74 BCa patients to build reference spectra of normal bladder tissue and of bladder cancers of different pathological types. Then, another 53 BCa patients were randomly categorized into two groups, 26 patients accepted traditional TURBT, 27 patients accepted TURBT followed by Raman scanning and cryoablation if Raman detected existence of residual tumor. The recurrence rates of the two groups until Oct 2022 were compared. Raman was capable of discriminating normal bladder tissue and BCa with a sensitivity and specificity of 90.5% and 80.8 %; and discriminating invasive (T1, T2) and noninvasive (Ta) BCa with a sensitivity and specificity of 83.3 % and 87.3 %. During follow-up, 2 in 27 patients had cancer recurrence in Raman-Cryoablation group, while 8 in 26 patients had cancer recurrence in traditional TURBT group. Combined use of Raman and cryoablation significantly reduced cancer recurrence (p = 0.0394). Raman and cryoablation can serve as an adjuvant therapy to TURBT to improve therapeutic effects and reduce recurrence rate.

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.

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. 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. 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. 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.

Survival Outcome of Partial Cystectomy versus Transurethral Bladder Tumor Resection in T1 High-Grade Bladder Cancer Patients: A Propensity Score Matching Study.

Partial cystectomy was investigated as a method of bladder preservation with better disease outcomes than transurethral bladder tumor resection in T1 high-grade bladder cancer patients. Method and materials. The national Surveillance, Epidemiology, and End Results database (SEER) (2004-2015) were used to obtain patients diagnosed with T1 high-grade bladder cancer, and finally, 25263 patients were enrolled in our study. The Kaplan-Meier method with the log-rank test was performed to analyze the outcome of overall survival (OS) and cancer-specific survival (CSS) between patients undergoing partial cystectomy (PC), transurethral resection of bladder tumor (TURBT), or radical cystectomy (RC). Moreover, the propensity score matching (PSM) and multivariable Cox proportional hazard model were also utilized in the study. Ultimately, 24635 patients were undergoing TURBT, while 190 and 438 patients were, respectively, assigned to the PC and RC groups. Compared with patients with TURBT, a tendency of a higher proportion of higher older and male patients was observed in the PC group. When matching with RC patients, patients in the PC group were commonly older and had bigger tumor sizes and single tumors (All P < 0.05). After 1 : 1 PSM, 190 patients with TURBT and 160 patients receiving PC were selected. In survival analysis, the patients in the PC group had a higher survival probability of both OS and CSS before and after PSM compared with those in the TURBT group. Meanwhile, no significant differences were observed between the RC and PC groups in OS and CSS analysis. Moreover, multivariable Cox regression showed that PC was a protective factor for overall mortality (ACM) and cancer-specific mortality (CSM) compared with TURBT in T1 high-grade patients (All P < 0.05). Patients undergoing partial cystectomy were shown to have a better outcome compared with those with transurethral bladder tumor resection in T1 high-grade bladder cancer patients. Partial cystectomy could be the more worthwhile choice for bladder preservation in T1 high-grade bladder cancer patients.

The efficiency of thulium laser en-bloc transurethral resection of non-muscularinvasive bladder tumors

Introduction. The current treatment for primary NMIBC is the transurethral resection of bladder tumor (TURBT) which is combined with postoperative intravesical instillation. It has been proven that the rate of disease recurrence depends on the quality of the primary surgical operation. Due to the development of laser surgery, the appearance of holmium (Ho:YAG) and later, in the 1990s, the appearance of thulium (Tm:YAG) lasers, the en-bloc laser resection was possible. The aim of this research was to compare result after Thulium laser En-bloc transurethral resection and transurethral resection of non-muscular invasive urinary bladder tumors. Material and methods. Between February 2017 and May 2019, within the Urology Clinic of Nicolae Testemitanu State University of Medicine and Pharmacy 65 patients with bladder tumor pathology were surgically treated. Patients were divided in two groups: Thulium laser En-bloc transurethral resection group which includes 32 patients and transurethral resection group with 33 patients. The obtained data were comparatively analyzed. Results. Tumor analysis showed that in most of the cases tumors were localized on the lateral walls of the bladder, a tumor up to 3 cm in size was detected in 71% of cases (46 patients) and single bladder tumors were detected in 65% of cases (42 patients) included in the study. Detrusor muscle was detected in 73% of cases in the TURBT group and in 97% of cases in the TmLRBT group. The majority of recurrences during the 12-month follow-up occurred in the TURBT group 39% (13 cases) in initial resection area 54% (7 cases). For TmLRBT group recurrence rate was 15% (5 cases), recurrence occurred predominantly in the non-primary resection area 80% (4 cases). Conclusions. The Thulium laser En-bloc transurethral resection of non-muscle-invasive bladder tumor (TmLRBT) proved to be an effective and safe method of treatment compared to the conventional transurethral resection (TURBT). This technique allows the obtaining of tumor samples in a higher quality (detrusor muscle is present in more cases), contributing to a correct diagnosis and staging of the disease. Finally, it leads to more favorable results and reduction of recurrence rate.

The Use of BT-ESD Technology under General Intravenous Anesthesia in the Treatment of Nonmuscle Invasive Bladder Cancer and the Effect of PI3K/Akt Signaling Pathway on Tumor Recurrence

Objective. The objective is to investigate the effect of minimally invasive treatment of nonmuscle invasive bladder cancer (NMIBC) by transurethral endoscopic submucosal dissection of bladder tumor (BT-ESD) under general intravenous anesthesia and the expression of Akt in NMIBC and to study the effect of upregulation of intracellular phosphatidylinositol kinase (PI3K)/protein kinase B (Akt) on tumor recurrence. Method. 130 patients with NMIBC were selected as the research subjects, including 101 males and 29 females. The patients were divided into transurethral resection of bladder tumor (TURBT) group, BT-ESD learning group A (early 20 cases of chief surgeon), and BT-ESD learning group B (follow-up cases of the chief surgeon). The general information (male and female prevalence ratio and average age), operation duration, postoperative bladder irrigation duration, postoperative indwelling catheter time, postoperative hospitalization time, and postoperative complications were compared among the patients in all groups. The normal bladder tissues and pathological tissues of NMIBC patients were stained by immunohistochemistry. Results. No significant difference is identified in age among the three groups (P&gt;0.05), but there are significant differences in the operation duration, postoperative bladder irrigation time, postoperative indwelling catheter time, and postoperative hospital stay (P&gt;0.05). At the same time, compared with BT-ESD group A and BT-ESD group B, the number of postoperative complications in TURBT group is statistically different (P&lt;0.05). Akt has a strong positive expression in the nucleus of patients, which indicates that Akt activated by cellular PI3K will form the PI3K/Akt signaling pathway and reduce the recurrence rate of bladder tumor.

Holmium LASER in Comparison with Transurethral Resection of the Bladder Tumor for Non-muscle Invasive Bladder Cancer: Randomized Clinical Trial with 18-month Follow-up.

To evaluate the safety and efficacy of holmium LASER resection of the bladder tumor (HoLRBT) vs. transurethral resection of bladder tumor (TURBT) as the first treatment modality for non-muscle-invasive bladder cancer (NMIBC). Eighty-eight patients with primary non-muscle invasive bladder cancer were allocated randomly in two groups who were treated with HoLRBT or TURBT. The intraoperative and postoperative characteristics and complications of the HoLRBT and TURBT groups were compared. The data of operation time, obturator nerve reflex rate, bladder perforation, bladder irrigation, catheterization time, hospital stay, and 1, 3, 6, 12, 18 months recurrence free survivals were considered in two groups. There was not significant difference in operative duration among the two groups. Compared with the TURBT group, HoLRBT group had less intraoperative and postoperative complications, including obturator nerve reflex, transient hematuria and postoperative bladder irritation. There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoLRBT group had less catheterization and hospitalization time in comparison to those in the TURBT group. There were no significant differences in the overall recurrence rate among the TURBT and HoLRBT groups. HoLRBT can be regarded as a safe and efficient method with several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in patients with non-muscle invasive bladder cancer.

Outcomes of stratified transurethral resection of bladder tumor: A propensity score-matched analysis

Several strategies have been reported for improving the integrity of transurethral resection of bladder tumor (TURBT). However, no standard has been established. Stratified TURBT (SR) is one of protocols for TURBT, wherein exophytic tumors are first resected and retrieved, and tumor bases are then resected. In this study, we aimed to evaluate the outcomes of SR in patients with nonmuscle invasive bladder cancer (NMIBC). From January 2012 to December 2017, patients newly diagnosed as having NMIBC with a follow-up period of more than 2 years were enrolled and categorized into SR and conventional TURBT (CR) groups. Propensity score matching at a 2:1 ratio was performed. Outcomes were the detrusor muscle sampling rate, recurrence-free survival (RFS), and progression-free survival (PFS). In total, 205 patients were included in our study. The detrusor muscle sampling rate was higher in the SR group (P=0.043). After propensity score matching, 162 patients were selected for outcome analysis, with 108 and 54 patients undergoing SR and CR, respectively. Compared with the CR group, the SR group showed a lower recurrence rate (P=0.015) and better RFS in univariate (P=0.010) and multivariate (P=0.006) Cox proportional hazards regression. Progression rate and PFS were not significantly different between the two groups. SR results in a higher detrusor muscle sampling rate and better disease outcomes. Our findings suggest that SR is a promising strategy for TURBT in patients with NMIBC.

A prospective study comparing side-firing KTP laser enucleation vs bipolar transurethral resection of bladder tumor for small bladder tumors in an outpatient setting.

IntroductionLaser therapy provides an alternative option for treating non-muscle-invasive bladder cancer. The clinical evidence for potassium-titanyl-phosphate (KTP) laser en bloc resection is still limited. Here, we evaluated the efficacy, safety profile, and outcomes of side-firing KTP laser enucleation with bipolar transurethral resection of bladder tumor (TURBT) in carefully selected patients with small bladder tumors in an office setting.Material and methodsA total of 83 patients with small bladder tumors were treated with either side-firing KTP laser enucleation (Group A; n = 40) or bipolar TURBT (Group B; n = 43). Intraoperative and postoperative parameters of interest were recorded and analyzed as per the study so as to evaluate the efficacy, safety profile, and outcome of KTP laser enucleation.ResultsThe mean enucleation time was 23 ±5.24 min in Group A and the mean operative time was 21.98 ±4.77 min in Group B (p = 0.207). Group A had a lower risk of obturator reflex (0 vs 8; p = 0.005) and lesser amount of irrigation used intraoperatively as compared to Group B (6.2 ±0.61 L vs 7.65 ±0.75 L; p <0.0001). There were no perioperative complications. The recurrence rate at 6 months was none in Group A and 2.3% in Group B.ConclusionsThe present study shows that, in patients with small bladder tumors (<3 cm), KTP laser enucleation is an effective and feasible alternative to bipolar TURBT in an office setting and can be carried out safely with comparable treatment outcomes, lesser use of irrigation fluid and lower risk of obturator reflex. However, further studies in larger cohorts are warranted.

Influences of Different Operative Methods on the Recurrence Rate of Non-Muscle-Invasive Bladder Cancer.

To compare the influence of three operative approaches [transurethral en bloc resection of bladder tumor by pin-shaped electrode (pin-ERBT), transurethral resection of bladder tumor (TURBT) and transurethral holmium laser resection of bladder tumor (HoLRBT)] on the recurrence rate of non-muscle-invasive bladder cancer (NMIBC) at low dimension (i.e. diameter below 3 cm). A retrospective analysis was conducted for a total of 115 patients affected by solitary NMIBC, with a diameter <3 cm, who were submitted to operation between March 2013 to May 2017. The patients were divided according to the operative method applied (pin-ERBT, TURBT and HoLRBT groups, respectively). The 2-year recurrence rate was compared among the three groups, and multivariat Cox hazard model analysis was applied to analyze the influencing factor(s) for postoperative recurrence. The 2-year recurrence rate was 10.0% in ERBT, 38.5% in TURBT and 40.0% in HoLRBT group, with a significant difference (P=0.014). According to the Cox hazard model analysis, age(HR=1.058, 95% CI: 1.019~1.098，P=0.003), operative method(HR=2.974,6.508, 95% CI: 0.862~10.255,1.657~25.566, P=0.023), smoking(HR=2.399, 95% CI: 1.147~5.017, P=0.020) and pathological grade(HR=2.012,95% CI: 1.279~3.165, P=0.002) were risk factors for postoperative recurrence of bladder cancer. Pin-ERBT can prominently decrease the postoperative recurrence rate of solitary NMIBC with a diameter <3 cm.

Transurethral en bloc resection with monopolar current for non-muscle invasive bladder cancer based on TNM system.

BackgroundTo evaluate the surgical safety and quality of transurethral en bloc resection with monopolar current for non-muscle invasive bladder cancer (NMIBC) based on the tumour, node, metastasis (TNM) classification system, and report the midterm oncological outcome.MethodsFrom October 2015 to June 2017, en bloc resection of bladder tumor (ERBT) and transurethral resection of bladder tumor (TURBT) were performed in 96 and 87 patients clinically diagnosed with NMIBC in the prospective case-control trial, respectively. Operative details, intraoperative and postoperative complications regarded as safety outcomes were documented. The quality of ERBT was judged by the histopathological examination of tumor specimens from initial resection and second TURBT, random bladder biopsy and follow-up recurrence rate.ResultsOperative time, obturator nerve reflex, irrigation and catheterization time were similar in the two groups. Bladder perforation was occurred in 2 patients during ERBT and 9 patients during TURBT (2/96 vs. 9/87, P=0.019). Compared with TURBT group, the ratio of detrusor muscle (DM) identified in pathologic T1 tumor specimens was higher (P=0.024), but lower in pathologic Ta tumor specimens in ERBT group (P<0.001). The residual tumor identified in ERBT group was lower than that in TURBT group during second TURBT (2/28 vs. 10/32, P=0.020). The recurrence-free survival rate did not differ significantly between the two groups after 24 months follow-up.ConclusionsERBT based on TNM system is a safe and feasible technique to treat patients with NMIBC. Besides, ERBT may reduce the proportion of bladder perforation and residual tumor during initial resection.

Observation and mechanism study of bladder wound healing after transurethral holmium laser resection of bladder tumor.

This research aims to observe and compare the wound healing process of urethral bladder after transurethral holmium laser resection of bladder tumor (HoLRBT) and transurethral resection of bladder tumor (TURBT) and explore the possible mechanism of wound healing and bladder re-epithelialization after HoLRBT. An animal model of canine achieving HoLRBT and TURBT was established. Cystoscopy was performed at different time points (3days and 1, 2, 3, and 4weeks) after operation to observe the wound healing and re-epithelialization of bladder epithelium. Bladder mucosa specimens were obtained and histopathological changes of the bladder epithelium were observed under light microscope after HE staining. Immunochemistry was used to determine the cell expression ofCK5, CK14, EGF, EGFR; microRNA expressions of CK5, CK14, EGF, and EGFR were measured by qRT-PCR. The changes of urinary EGF concentration were detected by ELISA. The bladder epithelial wound was repaired and re-epithelialized at 1week after HoLRBT. At the 4th week, the bladder wound was basically completed and re-epithelialized; repair of bladder epithelial wounds recapitulates the wounds with the proliferation and migration of residual epithelial cells under the wound and the bladder epithelium that proliferates alongside the wound surface to complete re-epithelialization. The process begins at 1week after surgery and basically completes at 4weeks after surgery. CK5 and CK14 positive cells were detected in the basal cells of the bladder epithelium after HoLRBT, and the expression of CK5 and CK14 mRNA in the basal cells of the bladder epithelium under hyperplasia was significantly higher than that of the normal bladder epithelial basal cells. Bladder epithelial wound repair of TURBT group was performed by the proliferative differentiation of the peri-bladder epithelium adjacent to the wound edge and crawled to the wound surface to complete the re-epithelialization process. The wound repair and re-epithelialization were significantly slower than HoLRBT group. The CK5 and CK14 positive cells can also be detected in the basal cells of marginal hyperplasia of basal margin, and the expression of CK5 and CK14 mRNA in the basal cells of the peri-bladder hyperplasia is obviously higher than that of the normal bladder epithelial basal cells. The expression of EGF in bladder regenerating epithelium gradually increased with time after HoLRBT. Bladder basal cells and bladder regenerating epithelium express high levels of EGFR after HoLRBT. The concentration of EGF in urine after HoLRBT and TURBT increased significantly after surgery, and peaked at 3days after operation. The urinary EGF concentration in HoLRBT group was higher than that in TURBT group at 3 and 4weeks after operation. The re-epithelialization process can be seen 1week after the cystectomy with holmium laser cystectomy, and the epithelialization rate is faster than the traditional transection surgery. This is because the residual bladder epithelial stem cells and wound marginal epithelial cells are involved in the process of wound repair and re-epithelialization following HoLRBT. But only the marginal epithelial tissue participates in the re-epithelialization process after TURBT, so the repair rate of TURBT is slower. The repair of bladder epithelium after HoLRBT is related to the stimulation of tissue factor EGF. The regenerated bladder epithelium also participates in the wound repair process by means of autocrine of EGF.

MP83-11 SINGLE OR TWO-TIME INTRAVESICAL INSTILLATION OF PIRARUBICIN AFTER TRANSURETHRAL RESECTION OF A SOLITARY NON-MUSCLE INVASIVE BLADDER CANCER: A PROSPECTIVE RANDOMIZED CONTROL STUDY

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2018MP83-11 SINGLE OR TWO-TIME INTRAVESICAL INSTILLATION OF PIRARUBICIN AFTER TRANSURETHRAL RESECTION OF A SOLITARY NON-MUSCLE INVASIVE BLADDER CANCER: A PROSPECTIVE RANDOMIZED CONTROL STUDY Ryuta Tanimoto, Saika Takashi, Shin Ebara, Yasuyuki Kobayashi, Ryoji Nasu, Yamada Daisuke, Hitoshi Takamoto, Yoshiyuki Miyaji, Yasutomo Nasu, Tomoyasu Tsushima, and Hiromi Kumon Ryuta TanimotoRyuta Tanimoto More articles by this author , Saika TakashiSaika Takashi More articles by this author , Shin EbaraShin Ebara More articles by this author , Yasuyuki KobayashiYasuyuki Kobayashi More articles by this author , Ryoji NasuRyoji Nasu More articles by this author , Yamada DaisukeYamada Daisuke More articles by this author , Hitoshi TakamotoHitoshi Takamoto More articles by this author , Yoshiyuki MiyajiYoshiyuki Miyaji More articles by this author , Yasutomo NasuYasutomo Nasu More articles by this author , Tomoyasu TsushimaTomoyasu Tsushima More articles by this author , and Hiromi KumonHiromi Kumon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2759AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Single immediate intravesical instillation of chemotherapy after transurethral resection of bladder tumor (TURBT) has been the gold standard treatment for patients with low- and intermediate-risk non-muscle invasive bladder cancer (NMIBC). Herein, we conducted a multicenter prospective randomized controlled trial in Japan, comparing recurrence-free survival between single and two-time instillation of pirarubicin (THP) for solitary NMIBC. METHODS Between 2005 and 2009, 257 patients with solitary NMIBC were enrolled and randomized to single instillation of THP (30 mg/50 mL) immediately after TURBT (Group A) or two-time instillation of THP immediately after and 1 day after TURBT (Group B). The primary endpoint was recurrence-free survival. Secondary endpoints included rates of recurrence and adverse effects, including hematuria, micturition pain, difficult urination, pollakiuria, systemic symptoms, and other complications. This study was registered as UMIN C000000266. RESULTS Of 257 patients, 99 in Group A and 102 in Group B could be evaluated for recurrence. Median follow-up was 71 months. The overall recurrence rate was 39% and 31%, respectively (p=0.2704). Although the 5-year recurrence-free survival rates were 55.9% and 67.7% in groups A and B, respectively, the difference between groups was not significant (p=0.2031). No significant differences in adverse effects were observed between groups, except for pollakiuria (7% vs 22%, p=0.0031). Multivariate analyses did not show that the treatment group was a significant risk factor for bladder cancer recurrence. CONCLUSIONS Postoperative two-time intravesical instillation of THP was not superior to single immediate instillation for preventing recurrence after complete resection of a solitary NMIBC. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1120 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ryuta Tanimoto More articles by this author Saika Takashi More articles by this author Shin Ebara More articles by this author Yasuyuki Kobayashi More articles by this author Ryoji Nasu More articles by this author Yamada Daisuke More articles by this author Hitoshi Takamoto More articles by this author Yoshiyuki Miyaji More articles by this author Yasutomo Nasu More articles by this author Tomoyasu Tsushima More articles by this author Hiromi Kumon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prospective randomized controlled trial of postoperative early intravesical chemotherapy with pirarubicin (THP) for solitary non-muscle invasive bladder cancer comparing single and two-time instillation.

Single immediate intravesical instillation of chemotherapy after transurethral resection of bladder tumor (TURBT) has been the gold standard treatment for patients with low- and intermediate-risk non-muscle invasive bladder cancer (NMIBC). Herein, we conducted a multicenter prospective randomized controlled trial in Japan, comparing recurrence-free survival between single and two-time instillation of pirarubicin (THP) for solitary NMIBC. Between 2005 and 2009, 257 patients with solitary NMIBC were enrolled and randomized to single instillation of THP (30mg/50mL) immediately after TURBT (Group A) or two-time instillation of THP immediately after and 1day after TURBT (Group B). The primary endpoint was recurrence-free survival. Secondary endpoints included rates of recurrence and adverse effects, including hematuria, micturition pain, difficult urination, pollakiuria, systemic symptoms, and other complications. This study was registered as UMIN C000000266. Of 257 patients, 99 in Group A and 102 in Group B could be evaluated for recurrence. Median follow-up was 71months. The overall recurrence rate was 39 and 31%, respectively (p=0.2704). Although the 5-year recurrence-free survival rates were 55.9% and 67.7% in groups A and B, respectively, the difference between groups was not significant (p=0.2031). No significant differences in adverse effects were observed between groups, except for pollakiuria (7 vs 22%, p=0.0031). Multivariate analyses did not show that the treatment group was a significant risk factor for bladder cancer recurrence. Postoperative two-time intravesical instillation of THP was not superior to single immediate instillation for preventing recurrence after complete resection of a solitary NMIBC.

Clinical comparison of transurethral resection of bladder tumor with 1470 laser and transurethral resection of bladder tumor

Objective To compare the time of indwelling catheter between en bloc resection of bladder tumor(EBRBT) with 1470 laser and transurethral resection of bladder tumor (TURBT) for the treatment of non-muscle invasive bladder cancer (NMIBC). Methods The clinical data of 64 NMIBC patients in our hospital from January 2016 to June 2017 who were divided into 29 cases of EBRBT group and 35 cases of TURBT group were retrospectively analysed, which included operation time, amount of bleeding, time of bladder irrigation, time of indwelling catheter after operation and average time of hospitalization. All patients were randomly selected, all operations have the same senior surgeon. Results All of the 64 operations were performed successfully. There was no significant difference in the operation time between the two groups (P>0.05). The intraoperative blood loss, the time of indwelling catheter and the average length of stay in EBRBT group were significantly less than those in TURBT group (P<0.05). Conclusions Transurethral laser treatment of 1470 for non-muscle invasive bladder cancer can effectively coagulate the wounds, reduce hematuria incidence, shorten the time of indwelling catheter and the average time of hospitalization, which is safer, less traumatic, convenient for nursing after surgery, and worthy of further clinical practice. Key words: Urinary Bladder Neoplasms; Cystectomy; Laser Therapy; Electrosurgery; Urethra

Preoperative Albumin Is Predictive of Early Postoperative Morbidity and Mortality in Common Urologic Oncologic Surgeries.

Multiple studies have linked preoperative nutrition status to postoperative outcomes. This relationship has been little studied in urology. We used a standardized, national, risk-adjusted surgical database to evaluate 30-day outcomes of patients undergoing common urologic oncologic procedures as they related to preoperative albumin. The American College of Surgeons National Surgical Quality Improvement Program is a risk-adjusted dataset analyzing preoperative risk factors, demographics, and 30-day outcomes. From 2005 through 2012, we identified a total of 17,805 patients who underwent prostatectomy, nephrectomy, partial nephrectomy, cystectomy, or transurethral resection of bladder tumor (TURBT). Hypoalbuminemic patients were compared with those with normal preoperative albumin, and 30-day outcomes were evaluated. Logistic regression analyses were used to estimate odds ratios for mortality and complication rates. Evaluation of the cohort noted significantly increased overall morbidity, serious morbidity, and mortality in the hypoalbuminemic group (P< .01 for all procedures). Hypoalbuminemia was associated with a significantly higher 30-day mortality in major procedures such as cystectomy, and in smaller procedures such as TURBT (P< .01). Hypoalbuminemia was associated with a 6.4% 30-day mortality in the TURBT group compared with 0.6% in those with normal albumin (P< .0001). These findings remained significant after adjustment for other risk factors. The large sample size, standardized data definitions, and quality control measures of the American College of Surgeons National Surgical Quality Improvement Program database allow for in-depth analysis of subtle but significant differences in outcomes between groups. Serum albumin is a strong predictor of short-term postoperative complications in the urologic oncology patient.

Comparative study of transurethral 1.9 μm thulium laser resection and standard transurethral electroresection for treating superficial bladder cancer

Objective To compare the efficacy and safety of 1.9 μm thulium laser with transurethral resection of bladder tumor(TURBT) for the treatment of superficial bladder cancer. Methods We reviewed 53 patients with superficial bladder cancer, who were divided into 1.9 μm laser(n=25)and TURBT groups(n=28)from January 2013 to December 2015.The operation time, blood loss volume in operation, catheter indwelling time, hospital stay time, and complications, cumulative recurrence rate were compared between the two groups. Results Compared to TURBT group, 1.9 μm laser group showed significantly lower rate of blood loss volume in operation(21.6±4.6)min, catheter indwelling time(22.4±6.4) h, hospital stay time(2.2±0.7) d, less complications(12%) and recurrence(16%)(P<0.05). Conclusions 1.9 μm thulium laser is safe and effective for the treatment of patients with superficial bladder cancer.The approach has less complications than TURBT. Key words: Urinary bladder neoplasms; 1.9 μm lasers; Electrocautery transurethral resection for bladder tumor; Comparative effectiveness research

MP01-08 NO DIFFERENCE IN PHYSICAL ACTIVITY IN BLADDER CANCER SURVIVORS TREATED WITH TRANSURETHRAL RESECTION OR RADICAL CYSTECTOMY.

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2016MP01-08 NO DIFFERENCE IN PHYSICAL ACTIVITY IN BLADDER CANCER SURVIVORS TREATED WITH TRANSURETHRAL RESECTION OR RADICAL CYSTECTOMY. Joseph Fantony, Ajay Gopalakrishna, Thomas Longo, and Brant Inman Joseph FantonyJoseph Fantony More articles by this author , Ajay GopalakrishnaAjay Gopalakrishna More articles by this author , Thomas LongoThomas Longo More articles by this author , and Brant InmanBrant Inman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1838AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With improving therapies, issues surrounding survivorship have come to the forefront of the urologic oncologist’s practice. Physical activity has been shown to quantitatively improve the quality of life in survivors of many malignancies, but has not been well studied in urothelial carcinoma. In this study we report the self-described physical activity patterns of bladder cancer survivors treated with transurethral resection of bladder tumor (TURBT) or radical cystectomy (RC). METHODS All bladder cancer survivors were obtained via a query of our electronic medical record, and mailed a survey that included the validated International Physical Activity Questionnaire-Long Form (IPAQ-L). Their responses were collected and stored in electronic capture form for scoring. RESULTS The questionnaire was mailed out to 968 people with 443 responses (46% response rate). Of the 443 respondents, 126 underwent RC and 317 had undergone TURBT as their most recent procedure. The median age for RC and TURBT was 71 and 73 respectively. The TURBT group was more likely to have been operated on more recently than was the RC group (4.6 years vs 7.1 years p<0.01). The questionnaire attempts to quantify both daily physical activity and “sitting time” (a measure of inactivity) measured in estimated metabolic equivalent-minutes per week (MET-min/week) and minutes per week (min/week) respectively. The TURBT group performed a mean 4,746.3 MET-min/week while the RC group performed 4,201.7 MET-min/week (p=0.36). Similarly, the “sitting time” was not significantly different with the TURBT group reporting 367.3 min/week and RC group reporting 330.8 min/week (p=0.151). CONCLUSIONS Despite the difference in the natural history of muscle invasive bladder cancer (or recurrent non-invasive disease) and non-muscle invasive cancer there appears to be no significant difference in the patient-reported levels of physical activity. This could be useful in the counseling of patients who may need to undergo extirpative treatment and have concerns regarding their ability to remain physically active after radical surgery with urinary diversion. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e4 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph Fantony More articles by this author Ajay Gopalakrishna More articles by this author Thomas Longo More articles by this author Brant Inman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does radical cystectomy outperform other bladder preservative treatments in elderly patients with advanced bladder cancer?

BackgroundTo assess the impacts of age, performance status, and clinical stage on advanced urothelial carcinoma of the bladder (UCB) in patients treated with different treatment modalities. MethodsThis retrospective study included 160 patients who underwent radical cystectomy (RC) with/without neoadjuvant or adjuvant chemoradiotherapy, palliative chemotherapy/radiotherapy/chemoradiotherapy (CRT), and transurethral resection of bladder tumor (TURBT) monotherapy for advanced UCB in one institution from 2000 to 2010. Kaplan–Meier analysis was used to calculate the survival distributions of overall survival (OS). The quality of life of the patients was also analyzed. ResultsThe median age of the patients was 74.0 years, and the mean survival interval was 31.5 months. The 2-year OS was significantly different among the three modalities [RC > TURBT monotherapy, odds ratio (OR): 1.86, 95% CI: 1.17–2.96, p = 0.009; CRT > TURBT monotherapy, OR: 1.65, 95% CI: 1.06–2.57, p = 0.026]. There were no significant differences in the 5- and 10-year OS rates between the three treatment modalities. Those younger than 76 years receiving RC had a significantly better 2-year OS than those undergoing CRT and TURBT monotherapy (RC > TURBT monotherapy, OR: 2.38; 95% CI: 1.30–4.33, p = 0.005). The number and duration of re-hospitalizations were highest in the CRT group and lowest in the TURBT group. ConclusionThe short- and long-term OS rates of the three modalities were similar in those older than 76 years. Therefore, patients younger than age 76 years are likely to have a better outcome undergoing radical cystectomy for advanced UCB.

A novel transurethral resection technique for superficial flat bladder tumor: grasp and bite technique.

PurposeTransurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT.Materials and MethodsMonopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups.ResultsOf 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique.ConclusionsThe grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner.

Comparative Study of 2um Laser versus Ho lmium Laser for the Resection of Non-Muscle Invasive Bladder Cancer

Objective: To compare the safety and efficacy of conventional monopolar transurethral resection of bladder tumor (TURBT), 2-micron continuous-wave laser and holmium laser resection techniques in the management of primary nonmuscle invasive bladder tumor (NMIBT). Methods: From January 2009 to January 2013, patients newly diagnosed primary NMIBC were enrolled in this study. The patients were divided into conventional TURBT group (n=70), holmium laser group (n=70) and 2-micron laser group (n=70) randomly. Operative time, postoperative bladder irrigation, catheterization time, hospitalization time, complications included obturator nerve reflex, bladder perforation, blood transfusion, and 2-year tumor recurrence rate were documented in all patients. Results: Characteristics of patients and tumors in all three groups were compared before surgery. There was no significant difference in operative time among the three groups. Compared with the conventional TURBT group, both 2-micron and holmium groups had less intra operative and postoperative complications, including obturator nerve reflex, bladder perforation, and postoperative bladder irritation. There were no significant differences among the three groups in the blood transfusion rate and incidence of urethral stricture. Patients in the 2-micron and holmium groups had less catheterization and hospitalization time than those in the conventional TURBT group. There was no significant difference in the 2-year tumor recurrence rate among the three groups. Conclusion: Our results demonstrated that the use of 2-micron (thulium) laser and holmium laser in the management of NMIBT were superior to conventional monopolar TURBT, while there were no significant differences between 2-micron laser and holmium laser. However, 2-micron laser and holmium laser did not have an obvious advantage over conventional TURBT in 2-year tumor recurrence rate. A longer follow-up period and larger numbers of patients are necessary to demonstrate the present result in the future.