Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt.
Int Urol Nephrol. 2023 Dec;55(12):3103-3109. doi: 10.1007/s11255-023-03752-5. Epub 2023 Aug 28.
Trans-Urethral Resection of Bladder Tumors (TURBT) is a critical step in diagnosis, staging and treatment of bladder tumors. Conventional TURBT (cTURBT) involves the electro-resection of the tumor into small fragments. This technique leads to concerns about the completeness of resection, under-staging, bleeding, cancer cell implantation, and most importantly, risk of tumour recurrence. To circumvent this, laser en-bloc resection of bladder tumors has been introduced.
Assessment of the safety, feasibility, and quality of Thulium Laser En-bloc Resection of Tumors (TmL-ERBT) for treatment of Non-Muscle Invasive Bladder Cancer (NMIBC) in various urinary bladder walls as a primary endpoint. The secondary endpoints were to investigate the feasibility of thulium laser use in the re-staging cystoscopy and to evaluate the learning curve of TmL-ERBT.
This is a prospective observational study including all newly diagnosed patients, above 18 years old, with a urinary bladder mass ≤ 4 cm in maximal dimension (measured via bladder ultrasound or CT or MRI). All patients underwent TmL-ERBT under regional anaesthesia in a lithotomy position. All intraoperative complications such as obturator nerve reflex, bladder perforation, and significant bleeding were recorded. Postoperative variables such as the mean catheterization time, bladder irrigation fluid volume and duration, and the mean of hospital stay as well as the postoperative complications were recorded. All patients were risk stratified and managed according to EUA guidelines then followed by a surveillance regimen per 3 months for 6 months.
The study included 23 patients with a mean age of 53 ± 15.8 years. While 15 patients (65%) had a single tumor, the rest had multiple tumors, ranging from 2 to 3 in number with a total of 36 lesions. No cases required conversion to cTURBT and none of them experienced obturator nerve reflex or bladder perforation. Only one patient (4.3%) had an attack of clot urine retention. The mean hospitalization time was 31.2 ± 14.4 h and the mean catheterization time was 20.4 ± 13.3 h. The Detrusor muscle was present in 20 patients (87%) and the remaining 3 patients required a re-staging cystoscopy which was performed efficiently using thulium laser. None of the treated patients developed tumour recurrence during the follow-up period. In analysis, the duration of complete resection of 2-4 cm tumours was 23-27 min after the 7th case with a resection rate of 0.12-0.15 cm/min.
TmL-ERBT is safe and feasible for complete resection of NMIBC with a short learning curve and adequate cancer control.
经尿道膀胱肿瘤切除术（TURBT）是诊断、分期和治疗膀胱肿瘤的关键步骤。传统的 TURBT（cTURBT）涉及到用电切术将肿瘤切成小块。这种技术导致了对切除的完整性、分期不足、出血、癌细胞种植以及最重要的肿瘤复发风险的担忧。为了解决这个问题，已经引入了膀胱肿瘤的钬激光整块切除术。
评估经尿道钬激光整块切除术（TmL-ERBT）治疗非肌肉浸润性膀胱癌（NMIBC）的安全性、可行性和质量，作为主要终点。次要终点是研究钬激光在重新分期膀胱镜检查中的可行性，并评估 TmL-ERBT 的学习曲线。
这是一项前瞻性观察性研究，纳入了所有新诊断的、年龄在 18 岁以上的、最大尺寸为≤4cm 的膀胱肿块患者（通过膀胱超声、CT 或 MRI 测量）。所有患者均在局部麻醉下以截石位行 TmL-ERBT。记录所有术中并发症，如闭孔神经反射、膀胱穿孔和明显出血。记录术后变量，如平均导尿管时间、膀胱冲洗液量和持续时间、平均住院时间以及术后并发症。所有患者均根据 EUA 指南进行风险分层和管理，然后根据随访方案每 3 个月随访 6 个月。
该研究纳入了 23 名平均年龄为 53±15.8 岁的患者。15 名患者（65%）有单个肿瘤，其余患者有多个肿瘤，数量从 2 到 3 个不等，共 36 个病灶。没有病例需要转换为 cTURBT，也没有病例出现闭孔神经反射或膀胱穿孔。只有 1 名患者（4.3%）出现血尿潴留。平均住院时间为 31.2±14.4 小时，平均导尿管时间为 20.4±13.3 小时。20 名患者（87%）的逼尿肌存在，其余 3 名患者需要进行重新分期膀胱镜检查，该检查使用钬激光有效地进行。在随访期间，没有接受治疗的患者出现肿瘤复发。在第 7 例患者后，2-4cm 肿瘤的完全切除时间为 23-27 分钟，切除率为 0.12-0.15cm/min。
TmL-ERBT 安全可行，可用于完全切除 NMIBC，学习曲线短，癌症控制效果好。
