Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to a...Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to assess the safety and efficacy of holmium resection of the bladder tumor （HoLRBT）vs. TURBT. Methods A systemic search of MEDLINE, Embase, Web of Science, and The Cochrane Library as well as manual bibliography searches were performed to identify the relevant studies. The pooled estimates of operation time, obturator nerve reflex rate, bladder perforation rate, bladder irrigation rate, catheterization time, hospital stay, and one- and two-year recurrence free survivals were calculated. Results Five studies were enrolled into our meta-analysis. No significant difference was observed in the operation time between groups （weighted mean difference （WMD） 1.01, 95% confidential interval （95% CI） -3.52-5.54, P=0.66）. The significant difference in the obturator nerve reflex （OR 0.05, 95% CI 0.01-0.04, P=0.004）, bladder perforation （OR 0.14, 95% CI 0.03-0.61, P=-0.009）, bladder irrigation （OR 0.13, 95% CI 0.04-0.45, P=0.001）, catheterization time （WMD -0.96, 95% C1-1.11 to-0.82, P 〈0.00001）, and hospital stay （WMD-1.46, 95% C1-1.65 to-1.27, P 〈0.00001）showed advantages of HoLRBT over TURBT. The 2-year recurrence free survival rate favors the HoLRBT group （OR 1.46, 95% CI 1.02-2.11, P=-0.04）. Conclusions As a promising technique, HoLRBT is safe and efficient, and showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in terms of low-grade papillary urothelial carcinoma or low-grade early TNM-stage urothelial carcinoma.展开更多
Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the co...Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.展开更多
目的:比较2μm激光、钬激光与经尿道膀胱肿瘤切除术(transurethral resection of the bladder tumor,TURBT)治疗非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)的有效性和安全性。方法:2011年6月至2013年6月期间,210例...目的:比较2μm激光、钬激光与经尿道膀胱肿瘤切除术(transurethral resection of the bladder tumor,TURBT)治疗非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)的有效性和安全性。方法:2011年6月至2013年6月期间,210例初诊为NMIBC患者被随机分到2μm激光手术组(n=70)、钬激光手术组(n=70)和TURBT手术组(n=70),记录手术时间、相关并发症、术后膀胱冲洗情况、留置导尿时间、住院时间。术后随访2年,定期行表柔比星膀胱灌注化疗和膀胱镜检查,记录膀胱肿瘤复发情况。结果:所有患者均顺利接受相应手术,2μm激光组、钬激光组和TURBT组的平均手术时间和输血率无统计学差异(P>0.05),TURBT组术中闭孔神经反射和膀胱穿孔发生率、术后需要膀胱冲洗病例、留置导尿时间、住院时间均高于2μm激光组与钬激光组,差异有统计学差异(P<0.05),且2μm激光组与钬激光组之间比较无明显差异。术后两年的随访研究中,共有24名患者失访,三组患者肿瘤复发率无统计学差异(P>0.05)。结论:2μm激光和钬激光在治疗NMIBC上优于传统的TURBT,2μm激光与钬激光两者之间临床疗效比较无明显差异。且TURBT、2μm激光和钬激光在术后肿瘤复发方面并无差异,下一步需要更多的病例数和更长的随访时间来验证本研究结果。展开更多
文摘Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to assess the safety and efficacy of holmium resection of the bladder tumor （HoLRBT）vs. TURBT. Methods A systemic search of MEDLINE, Embase, Web of Science, and The Cochrane Library as well as manual bibliography searches were performed to identify the relevant studies. The pooled estimates of operation time, obturator nerve reflex rate, bladder perforation rate, bladder irrigation rate, catheterization time, hospital stay, and one- and two-year recurrence free survivals were calculated. Results Five studies were enrolled into our meta-analysis. No significant difference was observed in the operation time between groups （weighted mean difference （WMD） 1.01, 95% confidential interval （95% CI） -3.52-5.54, P=0.66）. The significant difference in the obturator nerve reflex （OR 0.05, 95% CI 0.01-0.04, P=0.004）, bladder perforation （OR 0.14, 95% CI 0.03-0.61, P=-0.009）, bladder irrigation （OR 0.13, 95% CI 0.04-0.45, P=0.001）, catheterization time （WMD -0.96, 95% C1-1.11 to-0.82, P 〈0.00001）, and hospital stay （WMD-1.46, 95% C1-1.65 to-1.27, P 〈0.00001）showed advantages of HoLRBT over TURBT. The 2-year recurrence free survival rate favors the HoLRBT group （OR 1.46, 95% CI 1.02-2.11, P=-0.04）. Conclusions As a promising technique, HoLRBT is safe and efficient, and showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in terms of low-grade papillary urothelial carcinoma or low-grade early TNM-stage urothelial carcinoma.
文摘Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.
文摘目的:比较2μm激光、钬激光与经尿道膀胱肿瘤切除术(transurethral resection of the bladder tumor,TURBT)治疗非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)的有效性和安全性。方法:2011年6月至2013年6月期间,210例初诊为NMIBC患者被随机分到2μm激光手术组(n=70)、钬激光手术组(n=70)和TURBT手术组(n=70),记录手术时间、相关并发症、术后膀胱冲洗情况、留置导尿时间、住院时间。术后随访2年,定期行表柔比星膀胱灌注化疗和膀胱镜检查,记录膀胱肿瘤复发情况。结果:所有患者均顺利接受相应手术,2μm激光组、钬激光组和TURBT组的平均手术时间和输血率无统计学差异(P>0.05),TURBT组术中闭孔神经反射和膀胱穿孔发生率、术后需要膀胱冲洗病例、留置导尿时间、住院时间均高于2μm激光组与钬激光组,差异有统计学差异(P<0.05),且2μm激光组与钬激光组之间比较无明显差异。术后两年的随访研究中,共有24名患者失访,三组患者肿瘤复发率无统计学差异(P>0.05)。结论:2μm激光和钬激光在治疗NMIBC上优于传统的TURBT,2μm激光与钬激光两者之间临床疗效比较无明显差异。且TURBT、2μm激光和钬激光在术后肿瘤复发方面并无差异,下一步需要更多的病例数和更长的随访时间来验证本研究结果。
