Evaluation of Holmium (YAG)-Laser Transuretheral En bloc Resection in Patients with Primary Non-muscle Invasive Bladder Cancer

Abstract

Background: TURBT is the gold standard treatment for NMIBC. Lasers have been introduced as a minimally invasive option to decrease complication. Holmium and the 2-μm laser TURBT are the most frequently applied lasers in TURBT. The aim of this work was to evaluate Holmium Laser en bloc transurethral resection of bladder tumor (eTURBT) technique in resection of a primary bladder mass in terms of efficacy (Complete resection of the mass, histopathological staging and grading) and safety (operation time, blood loss, bladder perforation) and oncological outcomes (recurrence and progression). Methods: This pilot study included 40 patients with primary bladder mass scheduled for endourological staging procedure with primary solitary mass does not exceed 3 cm in largest dimension and two masses each of them isn't more than 2 cm in maximum diameter. Resection was done enbloc by karl storz 26fr resctoscope and using VersaPulse holmium(YAG) laser by lumenis. Results: Operative time had a mean ± SD of (37.01 ±5.50) min. The average enucleation time had a mean ± SD of (23.11± 6.26) min. blood loss had a mean ± SD of (0.3 ± 0.57). There was no need for blood transfusion at all. Bladder perforation occurred in only one case. Obturator jerk did not occur at all. Postoperative irrigation was indicated in only five cases (12.5%) with a mean ± SD was (1.21±3.32) hours. Postoperative urethral catheter time had mean ± SD was (28.38 ±9.22) hours.  Postoperative hospital stay ranged between 1-3 day.  In histopathological examination, All included cases revealed TCC, low grade in 19 patients (47.5%) and high grade in 21 patients (52.5%). All specimens contained bladder detrusor muscle, the pathological staging was pTa in 14 patients (35%), pT1 in 22 patients (55%) and pT2a in 4 patients (10%). Conclusions: Holmium laser transurethral en-bloc TURBT is an effective, feasible, and safe procedure for managing NMIBC, as it preserves the entire lamina propria and detrusor muscle in well-intact specimens which lowers recurrence and progression and decreases the need for a second look TURBT.