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

Abstract

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.

En Bloc Resection for Bladder Tumors: An Updated Systematic Review and Meta-Analysis of Its Differential Effect on Safety, Recurrence and Histopathology

“…11 In 24-month progression rates, Lu et al reported 9.2% (10/109) for ERBT and 10% (11/109) for cTURBT. 15 In 36-month progression rates, Zhang et al reported 5.4% (8/149) for ERBT and 7.0% (10/143) for cTURBT. 40 On the other hand, Chen et al reported no progression in both treatment arms during the 18-month followup.…”

“…According to our inclusion criteria, we finally identified 29 studies comprising 4,484 patients for meta-analysis. 9–16,24,25,29,36–50,51–53 Of 29 included studies, 13 RCTs comprising 1,792 patients were eligible for analysis of oncologic and perioperative outcomes, 9–16,36–40 and 5 RCTs and 16 NRCTs/observational studies comprising 3,369 patients were eligible for analysis of pathological and reTUR outcomes. 10–13,24,25,29,40–50,51–53 The demographics of each included study are represented in tables 1 and 2.…”

“…17–23 Moreover, as there have been increasing publications regarding this topic, 5 RCTs and 9 observational studies have been published since 2020. 10–12,15,16,25,41,42,45,47,49–52 Thus, we conducted this updated systematic review and meta-analysis of the potential utility of ERBT compared to cTURBT regarding oncologic outcomes only in RCTs and with a focus on its pathological utility.…”

“…17–19,21–23 Several prospective RCTs reported on the absence of obturator nerve reflex during ERBT particularly using laser and the consequently low risk of bladder perforation. 9,10,12,14–16,39,54 This, together with the supposed precision dissection of ERBT, is likely the explanation for the shorter catheterization and shorter hospitalization periods compared to cTURBT. 14–16,36,39…”

“…Several prospective randomized controlled trials (RCTs) of ERBT vs cTURBT assessed perioperative complications and oncologic outcomes. 9–16 Reports of these trials suggested that ERBT results in lower recurrence rates, however without any significant difference. In 6 different meta-analyses of ERBT vs cTURBT published between 2020 and 2021, including previous nonrandomized control trials (NRCTs) and observational studies, the oncologic benefit of ERBT versus cTURBT remained controversial depending on the included studies.…”