En bloc thulium laser resection of bladder tumors: 3-yr single centre experience

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Introduction & Objective: En bloc resection of bladder tumor is an oncologically appropriate technique, providing pathologist the entire tumor with its margins and resection bed. We report a 3-yr single-center experience of en bloc bladder tumor resection with thulium laser.
Materials and Methods: Data about 136 patients who underwent this technique were prospectively collected. Exclusion criteria were: tumors larger than 3 cm and patients with clinical evidence of muscle invasive disease who underwent a staging TURB. Perioperative and 3-yr oncologic outcomes were reported.
Results: Baseline and clinical data were summarized in Table 1. Mean operative time was 26.6 minutes; in 95 tumors (69.8%) laterally located obturator reflex was never observed and ureteral orifice was successfully spared in all cases (19; 14%) where it was involved. The overall complication rate was 5.1%, with no grade ≥3 Clavien complications occurring. Mean hospital stay was 1.6 days. Pathological reports are summarized in Table 2. Three-yr recurrence free survival rates for Ta low grade tumors and papillary urothelial neoplasms of low malignant potential and for T1 high grade tumors with negative ReTURB were 78.5% (Figure 1) and 80% (Figure 2), respectively.
Conclusions: Preliminary results suggest that en bloc thulium laser resection of bladder tumors is a safe and oncologically effective technique. Thulium laser allows surgeon to perform resection without obturator reflex and to spare ureteral orifices, making tumors laterally located and those involving the ureteral orifice the best targets for this technique.

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