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World Journal of Urology

, Volume 33, Issue 4, pp 571–579 | Cite as

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

  • Mario W. KramerEmail author
  • Mathias Wolters
  • Hannes Cash
  • Stephan Jutzi
  • Florian Imkamp
  • Markus A. Kuczyk
  • Axel S. Merseburger
  • Thomas R. W. Herrmann
Topic Paper

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.

Keywords

Laser En bloc Vaporization Bladder cancer Holmium Thulium 

Notes

Conflict of interest

The authors have no conflicts to declare in relation to this article.

References

  1. 1.
    Ploeg M, Aben KK, Kiemeney LA (2009) The present and future burden of urinary bladder cancer in the world. World J Urol 27(3):289–293. doi: 10.1007/s00345-009-0383-3 CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Sievert KD, Amend B, Nagele U, Schilling D, Bedke J, Horstmann M, Hennenlotter J, Kruck S, Stenzl A (2009) Economic aspects of bladder cancer: what are the benefits and costs? World J Urol 27(3):295–300. doi: 10.1007/s00345-009-0395-z CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Turrentine FE, Wang H, Simpson VB, Jones RS (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203(6):865–877. doi: 10.1016/j.jamcollsurg.2006.08.026 CrossRefPubMedGoogle Scholar
  4. 4.
    Kuo RL, Aslan P, Fitzgerald KB, Preminger GM (1998) Use of ureteroscopy and holmium:YAG laser in patients with bleeding diatheses. Urology 52(4):609–613CrossRefPubMedGoogle Scholar
  5. 5.
    Gross AJ, Herrmann TR (2007) History of lasers. World J Urol 25(3):217–220. doi: 10.1007/s00345-007-0173-8 CrossRefPubMedGoogle Scholar
  6. 6.
    Staehler G, Schmiedt E, Hofstetter A (1978) Destruction of bladder neoplasms by means of transurethral neodym-YAG-laser coagulation. Helv Chir Acta 45(3):307–311PubMedGoogle Scholar
  7. 7.
    Beer M, Jocham D, Beer A, Staehler G (1989) Adjuvant laser treatment of bladder cancer: 8 years’ experience with the Nd-YAG laser 1064 nm. Br J Urol 63(5):476–478CrossRefPubMedGoogle Scholar
  8. 8.
    Kramer MW, Bach T, Wolters M, Imkamp F, Gross AJ, Kuczyk MA, Merseburger AS, Herrmann TR (2011) Current evidence for transurethral laser therapy of non-muscle invasive bladder cancer. World J Urol 29(4):433–442. doi: 10.1007/s00345-011-0680-5 CrossRefPubMedGoogle Scholar
  9. 9.
    Cos LR, Di Sant’agnese PA (1988) ND: YAG nomogram dosimetry scale for the bladder. J Urol 139(1):196–198PubMedGoogle Scholar
  10. 10.
    Tao W, Yang D, Shan Y, Xue B, Sun C, Zang Y, Zhang Y (2013) Safety and efficacy of 120 W high performance system green light laser vaporization for non-muscle-invasive bladder cancer. J Xray Sci Technol 21(2):309–316. doi: 10.3233/XST-130379 PubMedGoogle Scholar
  11. 11.
    Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Comperat E, Sylvester RJ, Kaasinen E, Bohle A, Palou Redorta J, Roupret M (2013) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol 64(4):639–653. doi: 10.1016/j.eururo.2013.06.003 CrossRefPubMedGoogle Scholar
  12. 12.
    Syed HA, Talbot N, Abbas A, MacDonald D, Jones R, Marr TJ, Rukin NJ (2013) Flexible cystoscopy and Holmium:Yttrium aluminum garnet laser ablation for recurrent nonmuscle invasive bladder carcinoma under local anesthesia. J Endourol 27(7):886–891. doi: 10.1089/end.2012.0696 CrossRefPubMedGoogle Scholar
  13. 13.
    Yang Y, Wei ZT, Lu JS, Zu Q, Wang H, Zhang X (2012) Transurethral partial cystectomy with 2 mum thulium continuous wave laser in the treatment of bladder pheochromocytoma. J Endourol 26(6):686–690. doi: 10.1089/end.2011.0005 CrossRefPubMedGoogle Scholar
  14. 14.
    Liu H, Wu J, Xue S, Zhang Q, Ruan Y, Sun X, Xia S (2013) Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer. J Int Med Res 41(4):984–992. doi: 10.1177/0300060513477001 CrossRefPubMedGoogle Scholar
  15. 15.
    Wong KA, Zisengwe G, Athanasiou T, O’Brien T, Thomas K (2013) Outpatient laser ablation of non-muscle-invasive bladder cancer: is it safe, tolerable and cost-effective? BJU Int 112(5):561–567. doi: 10.1111/bju.12216 CrossRefPubMedGoogle Scholar
  16. 16.
    Zhong C, Guo S, Tang Y, Xia S (2010) Clinical observation on 2 micron laser for non-muscle-invasive bladder tumor treatment: single-center experience. World J Urol 28(2):157–161. doi: 10.1007/s00345-010-0532-8 CrossRefPubMedGoogle Scholar
  17. 17.
    Hossain MZ, Khan SA, Salam MA, Hossain S, Islam R (2005) Holmium YAG laser treatment of superficial bladder carcinoma. Mymensingh Med J 14(1):13–15PubMedGoogle Scholar
  18. 18.
    Johnson DE (1994) Use of the holmium:YAG (Ho:YAG) laser for treatment of superficial bladder carcinoma. Lasers Surg Med 14(3):213–218CrossRefPubMedGoogle Scholar
  19. 19.
    Jonler M, Lund L, Bisballe S (2004) Holmium:YAG laser vaporization of recurrent papillary tumours of the bladder under local anaesthesia. BJU Int 94(3):322–325. doi: 10.1111/j.1464-410X.2004.04882.x CrossRefPubMedGoogle Scholar
  20. 20.
    Razvi HA, Chun SS, Denstedt JD, Sales JL (1995) Soft-tissue applications of the holmium:YAG laser in urology. J Endourol 9(5):387–390CrossRefPubMedGoogle Scholar
  21. 21.
    Soler-Martinez J, Vozmediano-Chicharro R, Morales-Jimenez P, Hernandez-Alcaraz D, Vivas-Vargas E, Santos Garcia-Vaquero I, Baena-Gonzalez V (2007) Holmium laser treatment for low grade, low stage, noninvasive bladder cancer with local anesthesia and early instillation of mitomycin C. J Urol 178(6):2337–2339. doi: 10.1016/j.juro.2007.08.034 CrossRefPubMedGoogle Scholar
  22. 22.
    Syed HA, Biyani CS, Bryan N, Brough SJ, Powell CS (2001) Holmium:YAG laser treatment of recurrent superficial bladder carcinoma: initial clinical experience. J Endourol 15(6):625–627. doi: 10.1089/089277901750426427 CrossRefPubMedGoogle Scholar
  23. 23.
    Das A, Gilling P, Fraundorfer M (1998) Holmium laser resection of bladder tumors (HoLRBT). Tech Urol 4(1):12–14PubMedGoogle Scholar
  24. 24.
    Saito S (2001) Transurethral en bloc resection of bladder tumors. J Urol 166(6):2148–2150CrossRefPubMedGoogle Scholar
  25. 25.
    Xishuang S, Deyong Y, Xiangyu C, Tao J, Quanlin L, Hongwei G, Jibin Y, Dongjun W, Zhongzhou H, Jianbo W, Lina W, Lin Y (2010) Comparing the safety and efficiency of conventional monopolar, plasmakinetic, and holmium laser transurethral resection of primary non-muscle invasive bladder cancer. J Endourol 24(1):69–73. doi: 10.1089/end.2009.0171 CrossRefPubMedGoogle Scholar
  26. 26.
    Zhu Y, Jiang X, Zhang J, Chen W, Shi B, Xu Z (2008) Safety and efficacy of holmium laser resection for primary nonmuscle-invasive bladder cancer versus transurethral electroresection: single-center experience. Urology 72(3):608–612. doi: 10.1016/j.urology.2008.05.028 CrossRefPubMedGoogle Scholar
  27. 27.
    Gao X, Ren S, Xu C, Sun Y (2008) Thulium laser resection via a flexible cystoscope for recurrent non-muscle-invasive bladder cancer: initial clinical experience. BJU Int 102(9):1115–1118. doi: 10.1111/j.1464-410X.2008.07814.x CrossRefPubMedGoogle Scholar
  28. 28.
    Yang Y, Wei ZT, Zhang X, Hong BF, Guo G (2009) Transurethral partial cystectomy with continuous wave laser for bladder carcinoma. J Urol 182(1):66–69. doi: 10.1016/j.juro.2009.02.154 CrossRefPubMedGoogle Scholar
  29. 29.
    Wolters M, Kramer MW, Becker JU, Christgen M, Nagele U, Imkamp F, Burchardt M, Merseburger AS, Kuczyk MA, Bach T, Gross AJ, Herrmann TR (2011) Tm:YAG laser en bloc mucosectomy for accurate staging of primary bladder cancer: early experience. World J Urol 29(4):429–432. doi: 10.1007/s00345-011-0686-z CrossRefPubMedGoogle Scholar
  30. 30.
    Rink M, Dahlem R, Kluth L, Minner S, Ahyai SA, Eichelberg C, Fisch M, Chun F (2011) Older patients suffer from adverse histopathological features after radical cystectomy. Int J Urol 18(8):576–584. doi: 10.1111/j.1442-2042.2011.02794.x CrossRefPubMedGoogle Scholar
  31. 31.
    Hess J, Tschirdewahn S, Szarvas T, Rossi R, Rubben H, Vom Dorp F (2011) Urothelial carcinoma of the bladder: evaluation by combined endoscopy and urine cytology: is incontrovertible assessment possible? Urologe A 50(6):702–705. doi: 10.1007/s00120-010-2502-6 CrossRefPubMedGoogle Scholar
  32. 32.
    Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS (2012) EAU guidelines on laser technologies. Eur Urol 61(4):783–795. doi: 10.1016/j.eururo.2012.01.010 CrossRefPubMedGoogle Scholar
  33. 33.
    De Nunzio C, Franco G, Cindolo L, Autorino R, Cicione A, Perdona S, Falsaperla M, Gacci M, Leonardo C, Damiano R, De Sio M, Tubaro A (2014) Transuretral resection of the bladder (TURB): analysis of complications using a modified Clavien system in an Italian real life cohort. Eur J Surg Oncol 40(1):90–95. doi: 10.1016/j.ejso.2013.11.003 CrossRefPubMedGoogle Scholar
  34. 34.
    Kramer MW, Abdelkawi IF, Wolters M, Bach T, Gross AJ, Nagele U, Conort P, Merseburger AS, Kuczyk MA, Herrmann TR (2014) Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer. Minim Invasive Ther Allied Technol. doi: 10.3109/13645706.2014.880065 PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Mario W. Kramer
    • 1
    • 2
    Email author
  • Mathias Wolters
    • 1
    • 2
  • Hannes Cash
    • 1
    • 2
  • Stephan Jutzi
    • 1
    • 2
  • Florian Imkamp
    • 1
    • 2
  • Markus A. Kuczyk
    • 1
    • 2
  • Axel S. Merseburger
    • 1
    • 2
  • Thomas R. W. Herrmann
    • 1
    • 2
  1. 1.Department of Urology and Urologic-OncologyHannover Medical SchoolHannoverGermany
  2. 2.Department of UrologyCharité – University Medicine BerlinBerlinGermany

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