Holmium Laser Resection of Large Bladder Tumors: Technique Description, Feasibility, and Histopathological Quality Analysis.

Autor: Iscaife A; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. Electronic address: iscaifeboni@yahoo.com.br., Ribeiro Filho LA; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Aparecido Pereira MW; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Gallucci FP; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Chade D; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Murta CB; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Cordeiro MD; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Cardili L; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Sarkis AS; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Srougi M; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil., Nahas WC; Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: Urology [Urology] 2022 Jul; Vol. 165, pp. 373. Date of Electronic Publication: 2022 May 04.
DOI: 10.1016/j.urology.2022.04.021
Abstrakt: Background: The HoLERBT (Holmium Laser En-bloc Resection of Bladder Tumors) has emerged as an alternative to classical TURBT (Transurethral Resection of Bladder Tumor). Recent randomized trial and meta-analysis corroborate with the benefits in pathological analysis, perioperative and long-term oncological outcomes. 1-3 However, the treatment of large tumors and the technique of extraction from the bladder is a problem to be overcome. 1 , 4 OBJECTIVE: To describe the laser resection of bladder tumors and demonstrate the feasibility of this procedure even for large tumors throughout a series of cases. It is also discussed the quality of the histopathological analysis.
Methods: A series of 8 cases randomized selected to be the pilot for a trial comparing TURBT and HoLERBT in large tumors (>3 cm) in progress was analyzed (Brazilian Registry of Clinical Trials number RBR-67npwrk). The perioperative data and 1-year outcomes were assessed and the quality of histopathological analysis after morcellation was evaluated in terms of histopathology, grade, and stage. The entire procedure of one case is shown in a step-by-step video.
Results: The mean follow-up was 12.6 months. The mean age was 59.6 (42-85) years, and the mean tumor size was 4.7 (4-8) cm. All the resections were En-bloc. There were 2 cases of NMIBC, 4 cases of MIBC, 1 paraganglioma, and 1 adenocarcinoma. The histopathological analysis confirmed the presence of detrusor muscle layer and accurate diagnosis and staging in all cases (100%). There were no perioperative Clavien-Dindo > 1 complications, no blood transfusion, and no bladder perforations. The histopathology analysis reveals excellent quality without artifacts of fulguration.
Conclusion: The holmium laser resection followed by morcellation of large bladder tumors is a feasible procedure. No complications occurred in our series of cases and all cases provided excellent material for histopathological analysis.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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