J P Struck1, A Karl2, C Schwentner3, T R W Herrmann4,5, M W Kramer6. 1. Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. 2. Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland. 3. Urologische Klinik, Diakonie Klinikum Stuttgart, Stuttgart, Deutschland. 4. Klinik für Urologie, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Schweiz. 5. Klinik für Urologie und Uro-Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland. 6. Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. mario.kramer@uksh.de.
Abstract
BACKGROUND: Modifications in resection techniques may overcome obvious limitations of conventionally performed transurethral resection (e. g., tumor fragmentation) of bladder tumors or provide an easier patient treatment algorithm (e. g., tumor vaporization). OBJECTIVES: The present review article summarizes the current literature in terms of en bloc resection techniques, histopathological quality, complication rates, and oncological outcomes. MATERIALS AND METHODS: A separate data search was performed for en bloc resection (ERBT, n = 27) and vaporization (n = 15) of bladder tumors. RESULTS: In most cases, ERBT is performed in a circumferential fashion. Alternatively, ERBT may be performed by undermining the tumor base via antegrade application of short energy impulses. Based on high rates of detrusor in specimens of ERBT (90-100%), a better histopathological quality is assumed. Significant differences in perioperative complication rates have not been observed, although obturator-nerve-based bladder perforations are not seen when laser energy is used. There is a nonstatistically significant trend towards lower recurrence rates in ERBT groups. Tumor vaporization may provide a less invasive technique for older patients with recurrences of low-risk bladder cancer. It can be performed in an outpatient setting. CONCLUSIONS: ERBT may provide better histopathological quality. Tumor vaporization is performed in health care systems where reimbursement is adequate.
BACKGROUND: Modifications in resection techniques may overcome obvious limitations of conventionally performed transurethral resection (e. g., tumor fragmentation) of bladder tumors or provide an easier patient treatment algorithm (e. g., tumor vaporization). OBJECTIVES: The present review article summarizes the current literature in terms of en bloc resection techniques, histopathological quality, complication rates, and oncological outcomes. MATERIALS AND METHODS: A separate data search was performed for en bloc resection (ERBT, n = 27) and vaporization (n = 15) of bladder tumors. RESULTS: In most cases, ERBT is performed in a circumferential fashion. Alternatively, ERBT may be performed by undermining the tumor base via antegrade application of short energy impulses. Based on high rates of detrusor in specimens of ERBT (90-100%), a better histopathological quality is assumed. Significant differences in perioperative complication rates have not been observed, although obturator-nerve-based bladder perforations are not seen when laser energy is used. There is a nonstatistically significant trend towards lower recurrence rates in ERBT groups. Tumor vaporization may provide a less invasive technique for older patients with recurrences of low-risk bladder cancer. It can be performed in an outpatient setting. CONCLUSIONS:ERBT may provide better histopathological quality. Tumor vaporization is performed in health care systems where reimbursement is adequate.
Authors: Mario W Kramer; Vincenzo Altieri; Rodolfo Hurle; Lukas Lusuardi; Axel S Merseburger; Jens Rassweiler; Julian P Struck; Thomas R W Herrmann Journal: Eur Urol Focus Date: 2017-01-11
Authors: Mathias Wolters; Mario W Kramer; Jan U Becker; Matthias Christgen; Udo Nagele; Florian Imkamp; Martin Burchardt; Axel S Merseburger; Markus A Kuczyk; Thorsten Bach; Andreas J Gross; Thomas R W Herrmann Journal: World J Urol Date: 2011-05-08 Impact factor: 4.226
Authors: Haider A Syed; Nicholas Talbot; Ahmed Abbas; Donald MacDonald; Robert Jones; Timothy J Marr; Nicholas J Rukin Journal: J Endourol Date: 2013-06-22 Impact factor: 2.942
Authors: D Oswald; M Pallauf; T R W Herrmann; C Netsch; B Becker; K Lehrich; A Miernik; D S Schöb; K D Sievert; A J Gross; J Westphal; L Lusuardi; S Deininger Journal: Urologe A Date: 2022-01-04 Impact factor: 0.639