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01.04.2015 | Topic Paper

Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014

verfasst von: Mario W. Kramer, Mathias Wolters, Hannes Cash, Stephan Jutzi, Florian Imkamp, Markus A. Kuczyk, Axel S. Merseburger, Thomas R. W. Herrmann

Erschienen in: World Journal of Urology | Ausgabe 4/2015

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Abstract

Introduction

Bladder cancer (BC) represents a growing health care problem worldwide. In times of tight budgets and an aging society, new strategies for the transurethral treatment of BC are needed. Laser devices used for tumor vaporization and/or en bloc resection provide an alternative to parvenu strategies.

Materials and methods

Medline/Cochrane search was performed using following terms: bladder cancer, urothelial carcinoma, laser, en bloc, vaporization, photoablation, holmium, thulium, Ho:YAG, Tm:YAG, HoLRBT and TmLRBT. Last date of search was February 12, 2014.

Results

Eighteen publications in English were identified including 800 patients (Ho:YAG = 652 patients and Tm:YAG = 148 patients). Data on en bloc resection techniques were presented in 10 publications, 7 publications provided data of tumor vaporization and one publication presented data on both. Level of evidence based on SIGN is mainly 3 (non-analytic studies); only three studies are level 2 (prospective case control studies). Tumor vaporization seems to be a promising alternative for the treatment of recurrent tumors in selected patients. It can be performed in an office-based approach without the need of general anesthesia. The use of photodynamic diagnostic might enhance surgical quality. The principle of en bloc resection should provide accurate staging in most cases; however, data on this important aspect are missing. Peri- and postoperative complications are scarce. Due to the nature of the energy source, bladder perforation caused by obturator nerve reflex is highly unlikely when using lasers. There is a trend toward decreased infield recurrence rates.

Conclusions

Lasers are potentially useful alternatives to conventional TURBT, but systematical assessments using standardized classification systems and well-designed RCTs are needed to make results comparable.

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Titel: Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014
verfasst von: Mario W. Kramer
Mathias Wolters
Hannes Cash
Stephan Jutzi
Florian Imkamp
Markus A. Kuczyk
Axel S. Merseburger
Thomas R. W. Herrmann
Publikationsdatum: 01.04.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 4/2015
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-014-1337-y

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Abstract

Introduction

Materials and methods

Results

Conclusions

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