Tm:YAG laser en bloc mucosectomy for accurate staging of primary bladder cancer: Early experience

Introduction: Exact pathological staging of bladder cancer is crucial for determination of further treatment. One limiting factor is the surgical 'incise and scatter' technique that might contribute to tumour recurrence. En bloc resection techniques are en emerging issue. We present initial results with Thulium:YAG (Tm:YAG) en bloc resection of bladder tumours for treatment and accurate staging of solitary transitional cell carcinoma of the bladder. Materials and methods: From June through October 2010, six patients were treated by TmLRBT (Thulium laser resection of bladder tumour). Inclusion criteria were solitary lesions, treatment naive patients and tumour localisation of the lower bladder wall and trigonum. En bloc resection was applied on all of the tumours. Two cold-cut biopsies from the tumour base were extracted. On five of the six patients, a re-resection was performed after 6 weeks. Results: Pathological evaluation revealed 1 patient with pTa G1, 2 patients with pTa G2 and 3 patients with pT1 G3. All of the resected specimens provided detrusor muscle, and all biopsies were positive for muscle cells. No intra-, peri- or post-operative complications were observed. Bladder irrigation was mandatory in only 50% of the patients. All patients were negative for residual TCC in re-resection 6 weeks after initial treatment. Conclusion: TmLRBT has been proven safe and effective for both, treatment and pathological staging of primary TCC of the bladder. Tm:YAG en bloc resection therefore could be an appropriate tool for accurate staging with possibly lower scattering potential for the assessment and treatment of patients with TCC.