V05-05: En-bloc excision of urothelial bladder cancers by holmium laser: a feasibility study.
En-bloc excision of bladder tumors may improve staging quality and perioperative morbidity and influence tumor recurrence. This study was designed to evaluate the feasibility, safety and efficacy of en-bloc holmium laser excision of bladder tumors.
Holmium laser excision of bladder tumor was performed in 40 consecutive patients with a pre-op diagnosis of superficial bladder tumor. Transurethral en-bloc excision with a small mucosal margin was performed with holmium laser energy (1.5-2.0 Joules with 40-50 Hz frequency). Tumor base biopsy was taken either by holmium laser or by punch biopsy forceps. Staging quality was measured by presence of detrusor muscle in the pathology specimen. Various perioperative parameters like bleeding and need for transfusion were analyzed.
The patient’s age ranged from 13 to 92 years with most patients in the 3rd and 4th decade. The tumor size varied from 1.5 cm to 9 cm. Single tumor was seen in 18 patients while others had multiple lesions (2-7). En-bloc excision was successfully achieved in all patients. The median operation duration was 20 min. Three-way catheter with irrigation was utilized in 16 patients with average postoperative irrigation of less than 1 day in these patients. The average catheterization time was less than 2 days and hospitalization of 3 days. Detrusor muscle was present in the histopathology report of 37 patients (92.5 %). None of the patients needed a switch to conventional TURBT. Overall complication rate was low (Clavien ? 3, n = 5 [12.5 %]). No patient needed blood transfusion and no patient had any obturator spasms or bladder perforation. At 4-hours post-op 35 patients had clear urine.
En-bloc holmium laser excision of bladder tumors is feasible safe and effective.