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

BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: TmL-ERBT is safe and feasible for complete resection of NMIBC with a short learning curve and adequate cancer control.

Laser and pneumatic lithotripsy in the endoscopic management of large ureteric stones: a comparative study.

OBJECTIVE: We compared the results of holmium laser and pneumatic intracorporeal lithotripsy for large ureteric calculi in terms of efficacy, safety and complications. METHODS: The study was conducted between April 2009 and October 2010. 80 patients divided into two equally matched groups were included in a prospective randomized trial including patients with a ureteric stone size of 0.5-2 cm. A holmium laser with a 550-µm fiber was employed in the laser lithotripsy (LL) group. The Swiss Lithoclast was used in the pneumatic lithotripsy (PL) group. RESULTS: Mean stone size was comparable in both groups, namely 13.1 mm in the PL group and 12.9 mm in the LL group. The early stone-free rate was equal in both groups, while the delayed stone-free rate was 95% in LL and 85% in PL. Stone migration occurred in 12 PL cases and in 5 LL cases. Ureteric perforation occurred in 3 LL cases and in 2 PL cases. Ureteric stricture occurred in 1 case following LL. CONCLUSION: Both PL and LL are effective and safe modalities in treating large ureteric stones with minor insignificant differences. A pneumatic system may be more efficient with regard to the cost-benefit ratio, which was not studied in the present work; further studies should address this issue.