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Petov V, Timofeeva E, Sukhanov R, Baniel J, Mustafin M, Fajkovic H, Morozov A, Teoh JY, Singla N, Laukhtina E, Herrmann TR, Shariat SF, Enikeev D. Prospective non-randomized comparison of transurethral laser en bloc resection vs. conventional resection of bladder tumors larger than 3 cm. Minerva Urol Nephrol 2024; 76:436-441. [PMID: 39051891 DOI: 10.23736/s2724-6051.24.05682-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND En bloc resection of bladder tumor (ERBT) is an established surgical treatment method for patients with non-muscle invasive bladder cancer (NMIBC) in tumors less than 3 cm. Data regarding the efficacy and safety of ERBT on larger than 3 cm tumors are sparse and its efficacy compared to conventional transurethral resection (TURBT) remains unclear. The aim of this study was to prospectively compare the feasibility, safety and oncological outcomes of laser (Tm-fiber) ERBT and TURBT in patients with primary bladder lesions ≥3 cm. METHODS A cohort of 45 patients who underwent surgery for primary NMIBC between February 2018 and March 2022 was collected prospectively. There was no randomization. All procedures were performed by two experienced surgeons. Inclusion criteria were as follows: age >18 years, primary Ta or T1 bladder tumor with a diameter of ≥3 cm, no more than 3 tumors and no history of upper tract urothelial carcinoma. Exclusion criteria were carcinoma in situ or invasion into muscle layer (≥T2). ERBT was performed with thulium fiber laser (IPG, Russia). Primary endpoints included efficacy with recurrence-free survival (RFS) at 3, 6 and 12 months. Secondary endpoints were safety parameters, perioperative data and specimen quality (the presence of muscle layer in specimens). RESULTS Twenty-eight patients underwent laser ERBT and 17 conventional TURBT. The location and size of the tumors were comparable in both groups. The success rate was 93.3% in the ERBT group with two cases of conversion from ERBT to TURBT. Detrusor muscle was present in 92.8% patients in the ERBT group versus 70.5% in the TURBT group (P=0.04). Obturator nerve reflex was observed only in the TURBT group: 17.6% vs. 0.0% (P=0.02). The frequency of other complications was comparable between the two groups. RFS was not statistically different between the two methods at 3 (93.9% vs. 94.1%, P=0.87), 6 (89.3% vs. 82.3%, P=0.5) and 12 months (89.3% vs. 70.6%, P=0.11). CONCLUSIONS Laser ERBT is a feasible and safe procedure to manage bladder tumors larger than 3 cm. While it seems safer than TURBT, its effect on efficacy remains to be assessed in larger trials.
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Affiliation(s)
- Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia -
| | - Ekaterina Timofeeva
- Institute for Clinical Medicine Named After N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Mansur Mustafin
- Institute for Clinical Medicine Named After N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - Harun Fajkovic
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jeremy Y Teoh
- Department of Surgery, S.H. Ho Urology Center, Chinese University of Hong Kong, Hong Kong, China
| | - Nirmish Singla
- Brady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas R Herrmann
- Urology Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical Scholl MHH, Hannover, Germany
- Stellenbosch University Western Cape, Stellenbosch, South Africa
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Division of Urology, Rabin Medical Center, Petah Tikva, Israel
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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Zhao L, Yu X, Zhu Z, Gu X, Zhou Z, Li Y. Comparative efficacy and safety of greenlight and thulium laser vaporization techniques for benign prostatic hyperplasia: a systematic review and meta-analysis. Lasers Med Sci 2024; 39:190. [PMID: 39042320 DOI: 10.1007/s10103-024-04143-7] [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: 01/18/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
This meta-analysis evaluates the efficacy and safety of greenlight (PVP) and thulium laser vaporization (ThuVAP) in Benign Prostatic Hyperplasia (BPH) treatment. A systematic literature search was conducted in databases including PubMed, Cochrane Library, EMBASE, CNKI, Wangfang, and VIP in November 2023. Following the PRISMA guidelines, a systematic review and meta-analysis of the primary outcomes of interest were performed. The review was prospectively registered on PROSPERO under the registration number CRD42023491316. A total of 13 studies were included. The results of the meta-analysis showed that compared to PVP, ThuVAP had a shorter operation time (MD: 8.56, 95% CI: 4.10 ~ 13.03, p = 0.0002), and higher postoperative transfusion (OR:0.26, 95% CI: 0.10 ~ 0.64, p = 0.004). However, no significant differences were observed between the two groups in terms of length of stay (MD: -0.32, 95% CI: -0.78 ~ 0.14, p = 0.17), catherization time (MD: 0.03, 95% CI: -0.13 ~ 0.19, p = 0.73), international prostate symptom score improvement (MD: 0.23, 95% CI: -0.36 ~ 0.81, p = 0.45), quality of life improvement (MD: 0.04, 95% CI: -0.04 ~ 0.12, p = 0.29), maximum urinary flow rate improvement (MD: -0.59, 95% CI: -1.42 ~ 0.24, p = 0.16), postvoid residual urine volume improvement (MD: 1.04, 95% CI: -6.63 ~ 8.71, p = 0.79), overall postoperative complications (OR:1.15, 95% CI: 0.65 ~ 2.03, p = 0.63), postoperative bleeding (OR:1.18, 95% CI: 0.67 ~ 2.07, p = 0.56), re-peration (OR:0.55, 95% CI: 0.16 ~ 1.95, p = 0.35), urethral stricture (OR:0.90, 95% CI: 0.46 ~ 1.75, p = 0.75), and urinary incontinence (OR:1.07, 95% CI: 0.64 ~ 1.78, p = 0.80). The results of subgroup analysis showed that the results of comparing thulium vaporesection or vapoenucleation with PVP were consistent with the results of the pooled analysis. Both greenlight and thulium laser vaporization are effective and safe, with comparable surgical and functional outcomes. The choice between these methods should be based on patient-specific factors.
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Affiliation(s)
- Luheng Zhao
- Department of Urology, Second People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan Province, China.
| | - Xiaojia Yu
- Department of Nephrology, First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan Province, China
| | - Zhihu Zhu
- Department of Urology, Second People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan Province, China
| | - Xinglong Gu
- Department of Urology, Second People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan Province, China
| | - Zhiyong Zhou
- Department of Urology, Second People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan Province, China
| | - Yong Li
- Department of Urology, Second People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan Province, China
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Yao Q, Niu H, Yang X, Jiang H, Zhou Y, Shekhawat AS, Xue B. A novel laser resection approach: efficacy of rotatable bi-channel en bloc resection of bladder tumor in a pilot in-vivo study. Lasers Med Sci 2024; 39:188. [PMID: 39037583 DOI: 10.1007/s10103-024-04147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
En bloc resection of bladder tumor (ERBT) involves removing bladder tumors and their base. Laser resection has been used to reduce complications including bleeding and obturator nerve reflex (ONR). We developed a novel approach (rotatable bi-channel en bloc resection of bladder tumor (RBC-ERBT)) and assessed its efficacy in a pilot in-vivo study to enhance laser ERBT's applicability in challenging bladder regions. In the laser RBC-ERBT procedure, lesions were excised by inserting a holmium laser through the rotating external working channel, while forceps were inserted through the internal working channel provided traction on the tissue. Fifteen laser RBC-ERBT procedures were performed in five different bladder areas of three live pigs. The technical success rate (TSR), procedure time, lesion size, occurrence of complications (bleeding, perforation, ONR), and detrusor muscle (DM) presence rate and DM thickness were evaluated. All 15 procedures were performed with a 100% TSR. The resections were successful in all bladder regions (posterior, left, right and anterior walls and dome). Median procedure time was 20 min. The resected specimen size was 10 mm × 7 mm to 17 mm × 13 mm. Mild bleeding occurred in two procedures (13.3%) but was effectively managed. No incidents of ONR or perforation were observed. Histological examination confirmed presence of DM in all specimens with a median DM thickness of 1.26 mm. Our pilot in-vivo study suggested the feasibility and effectiveness of laser RBC-ERBT for bladder tumors in various locations. This technique offers effective traction, improved visualization, and enhanced laser accessibility. Further studies are required to validate its effectiveness in humans.
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Affiliation(s)
- Qiu Yao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215,004, China
| | - Hui Niu
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215,004, China
| | - Xibin Yang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, 215,004, China
| | - Huizhong Jiang
- Department of Operating Room, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215,004, China
| | - Yanling Zhou
- Department of Operating Room, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215,004, China
| | - Abhay Singh Shekhawat
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215,004, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215,004, China.
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Romero Otero J, Justo Quintas J, García Rojo E, Sopeña Sutil R, Peña Vallejo E, Lista Mateos F, Bozzini G, Saenz Calzada D, Rodríguez Antolín A, García Gómez B. Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort. Actas Urol Esp 2024; 48:371-376. [PMID: 38369292 DOI: 10.1016/j.acuroe.2024.02.010] [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: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate. MATERIAL AND METHODS All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications. RESULTS Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification. DISCUSSION With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data. CONCLUSIONS TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.
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Affiliation(s)
- J Romero Otero
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain.
| | - J Justo Quintas
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - E García Rojo
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - R Sopeña Sutil
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
| | - E Peña Vallejo
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain
| | - F Lista Mateos
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain; Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
| | - G Bozzini
- Servicio de Urología, Hospital Sant'Anna, San Fermo della Battaglia, Como, Italy
| | - D Saenz Calzada
- Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales y ROC Clinic, Móstoles, Madrid, Spain
| | - A Rodríguez Antolín
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain
| | - B García Gómez
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
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Herrmann J, Hartung FO, Kriegmair MC, Becker B, Lusuardi L, Herrmann TRW, Netsch C. [Should we all switch to en-bloc resection of bladder tumours?]. Aktuelle Urol 2024; 55:250-254. [PMID: 38653465 DOI: 10.1055/a-2252-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
In En-Bloc Resection of Bladder Tumours (ERBT), tumours are not removed in fragments, but are dissected in one layer and, if possible, extracted in one piece. This method represents a significant shift in the surgical management of non-muscle-invasive bladder tumours, providing multiple benefits over the traditional transurethral resection of the bladder (TUR-B). The histological analysis of ERBT specimens is more accurate, enhancing diagnostic precision. Additionally, the presence of detrusor muscle in ERBT specimens is more frequent, indicating a more complete removal of the tumours. Recent years have seen the consolidation of a robust evidence base emphasizing the advantages of ERBT. Notably, a multicentric, prospective randomized trial has recently revealed a significant reduction in recurrence rates at 12 months follow-up compared with TUR-B. Experienced endourologists should explore this technique, as it may soon become the standard of care. The technique's elegance and effectiveness make it too important to be ignored.
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Affiliation(s)
- Jonas Herrmann
- Urologie und Urochirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
| | | | | | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Lukas Lusuardi
- Urologie, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
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Yao Q, Jiang H, Niu H, Hu G, Liu X, Xue B. Prospective learning curve analysis of en bloc resection of bladder tumor using an ex vivo porcine model. BMC Surg 2024; 24:65. [PMID: 38374046 PMCID: PMC10877915 DOI: 10.1186/s12893-024-02355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND As a relatively new surgical technique, the learning curve of en bloc resection of bladder tumor (ERBT) in ex vivo models remains unaddressed. This study aimed to explore the learning curve of ERBT in an ex vivo porcine model. METHODS In this prospective study, eight endoscopists without prior experience in ERBT were divided into two groups: junior endoscopists, with less than 100 transurethral resection of bladder tumor (TURBT) procedure experience, and senior endoscopists, with at least 100 TURBT procedure experience. Each endoscopist performed 30 ERBT procedures on artificial lesions in an ex vivo porcine bladder model. The procedure time, perforation, en bloc resection status, and absence of detrusor muscle (DM) were recorded. The inflection points were identified using cumulative sum (CUSUM) analysis. Procedure results were compared between the two phases and two groups. RESULTS In all, 240 artificial lesions were successfully resected using ERBT. The CUSUM regression line indicated the inflection point at the 16th procedure for the junior endoscopists and at the 13th procedure for the senior endoscopists. In both groups, the procedure time, perforation, piecemeal resection, and DM absence rates were significantly lower in the consolidation phase than in the initial phase. The procedure time for the senior endoscopists was lower than for the junior endoscopists in both phases. CONCLUSIONS ERBT performance improved significantly after reaching the inflection point of the learning curve in the ex vivo model. We recommend a minimum of 16 ERBT procedures in ex vivo models for urologists with less than 100 TURBT experience and a minimum of 13 procedures for those with at least 100 TURBT experience before advancing to live animal training or supervised clinical practice.
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Affiliation(s)
- Qiu Yao
- Department of Urology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215000, Jiangsu, China
| | - Huizhong Jiang
- Department of Operating Room, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Hui Niu
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Guangmo Hu
- Department of Urology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215000, Jiangsu, China
| | - Xiaolong Liu
- Department of Urology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215000, Jiangsu, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215000, Jiangsu, China.
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Ortner G, Güven S, Somani BK, Nicklas A, Teoh JYC, Goumas IK, Bach T, Sancha FG, Figueredo FCA, Kramer MW, Bozzini G, Ulvik Ø, Kallidonis P, Roche JB, Miernik A, Enikeev D, Vaddi CM, Bhojani N, Sountoulides P, Lusuardi L, Baard J, Gauhar V, Ahmed A, Netsch C, Gözen AS, Nagele U, Herrmann TRW, Tokas T. 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. World J Urol 2024; 42:79. [PMID: 38353743 DOI: 10.1007/s00345-024-04786-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T, Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria.
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andre Nicklas
- Department of Urology and Andrology, General Hospital Hall I.T, Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Thorsten Bach
- Department of Urology, Asklepios Westklinikum Rissen, Hamburg, Germany
| | | | | | - Mario W Kramer
- Department of Urology, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | | | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Karl Landstainer Institute of Urology and Andrology, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Petros Sountoulides
- 1st Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lukas Lusuardi
- Departement of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ali Ahmed
- Department of Urology, Frimley Health, NHS Foundation Trust, Frimley, UK
| | | | - Ali Serdar Gözen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall I.T, Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
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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.
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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
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Nicoletti R, Gauhar V, Castellani D, Enikeev D, Herrmann TRW, Teoh JYC. Current Techniques for En Bloc Transurethral Resection of Bladder Tumor: A Hands-on Guide Through the Energy Landscape. Eur Urol Focus 2023:S2405-4569(23)00104-9. [PMID: 37179226 DOI: 10.1016/j.euf.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
En bloc resection of bladder tumor (ERBT) has attracted interest as a potentially superior technique to transurethral resection of bladder tumor (TURBT) to obtain detrusor muscle in the specimen. Different ERBT techniques have been described, with bipolar electrocautery and laser being the more favored energy modalities. Electrocautery EBRT has an advantage in terms of widespread availability in clinics and ease of conversion to piecemeal resection in case of large bladder tumors in different locations. Laser EBRT has an advantage in preventing obturator nerve reflex, which is particularly useful for lateral wall tumors. Further research is needed to assess the potential case-related advantages of the ERBT techniques over each other. PATIENT SUMMARY: Surgical removal of a bladder tumor as a whole single piece, called en bloc resection, is a safe procedure for the diagnosis and treatment of noninvasive bladder cancer. In this mini-review we summarize the evidence for current techniques for en bloc resection.
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Affiliation(s)
- Rossella Nicoletti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University Le Marche, Ancona, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China; European Association of Urology Young Academic Urologists Urothelial Carcinoma Working Group, Arnhem, The Netherlands.
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Scoffone CM, Cracco CM. Which is the Best Laser for Treatment of Benign Prostatic Hyperplasia? EUR UROL SUPPL 2023; 48:34-35. [PMID: 36588771 PMCID: PMC9798194 DOI: 10.1016/j.euros.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
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Wu K, Jiang D, Zhang L, Jiang S, Lin T, Luo Y, Fan J, Yang T, Chen H, Zhang P, Wang X, Wei Q, Guo J, Huang Y, He D. Efficacy and safety of a novel 450 nm blue diode laser versus plasmakinetic electrocautery for the transurethral resection of non-muscle invasive bladder cancer: The protocol and result of a multicenter randomized controlled trial. Front Oncol 2023; 12:1065735. [PMID: 36733358 PMCID: PMC9887014 DOI: 10.3389/fonc.2022.1065735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives To be the first to apply a novel 450 nm blue diode laser in transurethral resection of bladder tumor (TURBt) to treat patients with non-muscle invasive bladder cancer (NMIBC) and evaluate its efficacy and safety during the preoperative period compared to the conventional plasmakinetic electrocautery. Materials and Methods Randomized controlled trial (RCT) in five medical centers was designed as a non-inferiority study and conducted from October 2018 to December 2019. Patients with NMIBC were randomized to the blue laser or plasmakinetic electrocautery group for TURBt. As the first study to evaluate this novel blue laser device, the primary outcome was the effective resection rate of bladder tumors, including effective dissection and hemostasis. The secondary outcomes were the perioperative records, including surgical time, postoperative indwelling catheter time, hospital stay length, blood loss, reoperation rate, wound healing and adverse events. Results A total of 174 patients were randomized to either the blue laser group (85 patients) or plasmakinetic electrocautery group (89 patients). There was no statistical significance in the clinical features of bladder tumors, including tumor site, number and maximum lesion size. Both the blue laser and plasmakinetic electrocautery could effectively dissect all visible bladder tumors. The surgical time for patients in the blue laser group was longer (p=0.001), but their blood loss was less than that of patients in the control group (p=0.003). There were no differences in the postoperative indwelling catheter time, hospital stay length, reoperation rate or other adverse events. However, the patients undergoing TURBt with the blue laser showed a faster wound healing at 3 months after operation. Conclusion The novel blue laser could be effectively and safely used for TURBt in patients with NMIBC, and this method was not inferior to plasmakinetic electrocautery during the perioperative period. However, TURBt with the blue laser may provide the benefit to reduce preoperative blood loss and accelerate postoperative wound healing. Moreover, longer follow-up to confirm recurrence-free survival benefit was required.
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Affiliation(s)
- Kaijie Wu
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dali Jiang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lianhua Zhang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuai Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianhai Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Tao Yang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Haige Chen
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China,*Correspondence: Yiran Huang, ; Dalin He,
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,*Correspondence: Yiran Huang, ; Dalin He,
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Sierra A, Corrales M, Traxer O. Ureteroscopic laser treatment of upper tract transitional cell carcinoma. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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En-bloc Laser Resection of Bladder Tumors: Where Are We Now? J Clin Med 2022; 11:jcm11123463. [PMID: 35743533 PMCID: PMC9224997 DOI: 10.3390/jcm11123463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
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