Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer

Kramer, Mario W.; Altieri, Vincenzo; Hurle, Rodolfo; Lusuardi, Lukas; Merseburger, Axel S.; Rassweiler, Jens; Struck, Julian P.; Herrmann, Thomas

doi:10.1016/j.euf.2016.12.004

Cited by 118 publications

(84 citation statements)

References 39 publications

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“…Although it has been widely used for many years, multiple issues are still unresolved. The most frequently discussed topics are the risk of tumor cell scattering, tumor cell implantation, incomplete resection, missing detrusor muscle (DM), and thermal damage of specimens [6,21].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have reported the feasibility and practicability of laser ERBT, which can achieve better DM rates in comparison with cTURBT. Thus, resection quality can be improved, and the number of repeat transurethral bladder tumor resections (Re-TUR) can be reduced [22][23][24]. Consequently, the authors of this meta-analysis have systematically analyzed data of ERBT and cTURBT approaches for NMIBC regarding ef- fectivity and safety with the aim to adapt treatment to patients to achieve the best possible treatment outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of en bloc resection of bladder tumor (ERBT) was first proposed in a case report by Kawada et al [4] in 1997. Laser monolithic resection of bladder tumors, which was adopted in 1998 [5], aims to achieve 3 goals: reducing the incidence of perioperative complications, improving the quality of resection, and decreasing the recurrence rates [6]. ERBT has also been the focus of research by urologists for many years, and several studies have explored the safety and feasibility of cTURBT and ERBT.…”

Section: Introductionmentioning

confidence: 99%

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Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis

et al. 2020

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Background: En bloc transurethral resection (ERBT) is a major topic of discussion as an alternative to conventional transurethral resection (cTURBT) for the treatment of nonmuscle-invasive bladder cancer (NMIBC) addressing the limitations of cTURBT. Methods: We searched through electronic databases including Embase, Cochrane Library, MEDLINE, Web of Science, PubMed, and Google Scholar for articles published up to April 1, 2019; RevMan 5.3 was used to conduct this meta-analysis. Results were expressed as 95% confidence intervals (CI) and risk differences (RD). Results: Nine trials met the inclusion criteria (n = 1,020 patients): 1 study was a randomized controlled trial including a total of 142 participants, 4 studies had a prospective paired design including 605 patients, and 4 studies were retrospective (n = 273 patients). Duration of continuous postoperative bladder irrigation (RD -0.16; 95% CI -3.47 to 0.28; I 2 = 97%; p = 0.10) and operation time (RD 0.05; 95% CI -0.23 to 0.32; I 2 = 79%; p = 0.74) were not significantly different between ERBT and cTURBT. However, hospitalization time (I 2 = 96%; χ 2 = 203.16; p = 0.01) and catheterization time (I 2 = 95%; χ 2 = 163.24; p = 0.02), as well as 24-month recurrence rate (I 2 = 0%; χ 2 = 0.98; p = 0.008) were significantly better using the ERBT scheme. The incidence of urethral stricture between both schemes (95% CI -0.03 to 0.02; p = 0.50) was not different, but complications such as obturator nerve reflex (95% CI 0.01 to 0.12; p < 0.00001) and bladder perforation (95% CI 0.05 to 0.59; p = 0.50) were less frequent in the ERBT group. Conclusion: ERBT is an effective treatment approach with some advantages for NMIBC. Our meta-analysis revealed that hospitalization time, catheterization time, and 24-month recurrence rate is superior in patients treated with ERBT than cTURBT, and ERBT patients also have a lower complication rate. Furthermore, ERBT improves the quality of tumor specimens and decreases the frequency of repeat transurethral bladder cancer resection. Further randomized controlled trials are needed to confirm our results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis

et al. 2020

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“…In fact, a dedicated pathologist is necessary to increase diagnostic accuracy and to reduce misinterpretations [8]. Currently, a new TURBT technique, en-bloc resection, is debated as an alternative to traditional TURBT to improve specimens quality, but it is not yet the standard of care [9]. Another important issue in UC treatment is the lack of sensitivity of white light cystoscopy, meaning some tumors may be missed, especially Carcinoma in situ, which is also associated with a higher rate of disease progression [10].…”

Section: Clinical Needsmentioning

confidence: 99%

Advanced multimodal laser imaging tool for urothelial carcinoma diagnosis (AMPLITUDE)

et al. 2020

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“…13 Surgery with holmium lasers exhibits minimal invasiveness, greater effectiveness, and improved safety, compared with traditional surgeries, during treatment of a variety of benign conditions such as strictures, benign prostatic hyperplasia, and bladder cancer. [14][15][16] In addition to surgical techniques, postoperative intravesical chemotherapy is an important component of bladder cancer treatment. 17 Many drugs can be used for administration of intravesical chemotherapy, including gemcitabine, epirubicin, and mitomycin.…”

Section: Introductionmentioning

confidence: 99%

Transurethral holmium laser resection and transurethral electrocision combined with intravesical epirubicin within 24 hours postoperatively for treatment of bladder cancer

Xue

Shen

et al. 2019

J Int Med Res

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Objective: To investigate the efficacy and safety of transurethral holmium laser resection (THOLR) and transurethral electrocision (TUR) combined with intravesical epirubicin within 24 hours postoperatively for treatment of non-muscular invasive bladder cancer. Methods: A total of 218 consecutive patients who were newly diagnosed with bladder cancer were enrolled in this prospective study from July 2014 to December 2017. The patients were randomly divided into THOLR and TUR groups. All patients received intravesical epirubicin (30 mg dissolved in 5% glucose solution) within 24 hours postoperatively. The operation time, blood loss, rate of obturator reflex, hospitalization time, catheterization time, complications, and recurrence were analyzed. Results: Operation, hospitalization, and catheterization times were significantly greater in the TUR group than in the THOLR group. The rates of blood loss and intraoperative obturator reflex were also significantly greater in the TUR group. There were no significant differences in complications, recurrence rate survival, or recurrence-free survival between the two groups, with the exception of bladder perforation rate. Conclusions: THOLR and TUR combined with intravesical epirubicin within 24 hours postoperatively were both safe and effective for treatment of bladder tumor; however, patients who undergo THOLR might experience more rapid recovery.

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Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer

Cited by 118 publications

References 39 publications

Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis

Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis

Advanced multimodal laser imaging tool for urothelial carcinoma diagnosis (AMPLITUDE)

Transurethral holmium laser resection and transurethral electrocision combined with intravesical epirubicin within 24 hours postoperatively for treatment of bladder cancer

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