ENDOSCOPIC EN BLOC ENUCLEATION OF NON MUSCLE-INVASIVE BLADDER TUMOR WITH THULIUM LASER (THULEBT)
To evaluate if thulium laser enucleation of bladder tumor (THULEBT) offers more accurate pathological tumor stage in respect to monopolar resection of non muscle-invasive bladder cancer (NMIBC) without increasing complications.
MATHERIALS AND METODS
From February 2012 to September 2013, 58 patients (41 male and 17 female) newly diagnosed with single papillary bladder tumor more than 1 cm in diameter were selected for this prospective study on THULEBT. A similar historical cohort of 61 patient who underwent monopolar resection of NMIBT was used to compare the two procedures.
A total of 72 neoplasms were removed with THULEBT from 58 patients. Mean tumor diameter was 2.5 cm (range, 0.5-4.5). Mean operative time was 25 minutes (range, 12-30). Cold-cup biopsy of the tumor base (in 90 days) was negative for BC persistence or recurrence in all patients with NMIBC treated with THULEBT. In Group B, 7 patients were found with a disease persistence. In 8 cases of TURB-T patients no detrusor muscle was identified, while it was always easily identified in THULEBT group. No patient experienced obturator nerve reflection intraoperatively and no bladder perforation were evidenced in dome located neoplasm. When involved, ureteral meatus was sharply excised without subsequent post-operative evidence of distortion. No significant intraoperative or postoperative bleeding occurred.
En bloc resection of bladder tumors may represent a potential alternative to TURB-T which nowadays is considered the standard for diagnosis and treatment of NMBIC. THULEBT allows accurate reporting of neoplastic depth invasion avoiding the need to restage bladder tumor at 90 days. All the different intravesical site of the BC may be enucleated with the thulium laser which could offer advantage over the monopolar energy especially when the tumor is positioned in the lateral bladder wall or in the bladder dome or in perimeatal zone.