Mp71-05 Comparison of Clinicopathological Outcomes in Holmium Laser en-Bloc Resection of Bladder Tumor vs Bipolar Transurethral Resection of Bladder Tumour

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-05 COMPARISON OF CLINICOPATHOLOGICAL OUTCOMES IN HOLMIUM LASER EN-BLOC RESECTION OF BLADDER TUMOR VS BIPOLAR TRANSURETHRAL RESECTION OF BLADDER TUMOUR Prasant Nayak, Prasanna Ram, Vivek Tarigopula, Manoj Kumar Das, Swarnendu Mandal, and Sambit Tripathy Prasant NayakPrasant Nayak , Prasanna RamPrasanna Ram , Vivek TarigopulaVivek Tarigopula , Manoj Kumar DasManoj Kumar Das , Swarnendu MandalSwarnendu Mandal , and Sambit TripathySambit Tripathy View All Author Informationhttps://doi.org/10.1097/01.JU.0001009548.76580.ba.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The conventional bipolar Transurethral-Resection-of-Bladder-Tumour (TURBT), though considered the standard- of-care, has inherent drawbacks. The piecemeal resection of the tumour goes against the oncological principles. The completeness of resection is often judged on the surgeon's intuition, and muscularis-propria is sampled separately from assumed tumour bed location later. The energy source comes in contact with specimen during each stroke. The Obturator Nerve Reflex (ONR), especially in lateral wall tumours, is not completely eliminated. We aim to study if Holmium-Laser en-bloc Resection-of-Bladder-Tumour (HoLERBT) can address these issues. METHODS: This was an ethics committee approved (PG Thesis/2022-23/40), Clinical-Trials-Registry-India (CTRI) registered (CTRI/2022/08/045042) open labelled, parallel-group, prospective-non-randomised study conducted in the department of urology at a single centre in India between September 2022 and April 2023. Patients with bladder tumours ≤5 cm, ≤5 in number were included. The decision of TURBT or HoLERBT is made after cystoscopy under anaesthesia by the operating surgeon. For HoLERBT, a five mm circumferential margin is marked around the tumour base using laser and the tumour is lifted all around by incising the mucosa. The resection plane is deepened at the centre to include muscularis-propria in same specimen. The specimen is retrieved intoto. The histopathological quality of the specimen is analysed based on the degree of thermal artefacts both qualitatively and quantitatively, and an Overall Artefact Score (OAS) is given. In the case of T1 tumours, the ability of the pathologist to subclassify the tumour is also noted. RESULTS: A total of 60 patients were included in the study, out of which, 20 underwent HoLERBT and 40 TURBT. The study groups did not differ in mean age, tumor size, and number. The incidence of ONR (n=0 vs 11) and deep- resection deemed ineligible for MMC instillation (n=4 vs 21) was significantly less with HoLERBT (p=0.04, 0.017, respectively). Both groups were comparable in the amount of irrigation fluid used for resection, resection time, length of postoperative hospital stay, and catheterisation time. Amongst T1 tumors, the pathologist was able to subclassify 90% of HoLERBT vs 57.8% of TURBT specimens. Muscularis-propria was not identified in one HoLERBT and four TURBT specimens. The HoLERBT specimens had significantly lesser thermal-artefacts both quantitatively and qualitatively [OAS 2(2-5) vs 3(2-6); p 0.003]. CONCLUSIONS: HoLERBT resulted in zero ONR and had better control of resection depth when compared to bipolar TURBT. Histopathological quality was significantly better with HoLERBT, especially in subclassifying the T1 tumours. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1162 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Prasant Nayak More articles by this author Prasanna Ram More articles by this author Vivek Tarigopula More articles by this author Manoj Kumar Das More articles by this author Swarnendu Mandal More articles by this author Sambit Tripathy More articles by this author Expand All Advertisement PDF downloadLoading ...