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World Journal of Urology

, Volume 33, Issue 12, pp 1937–1943 | Cite as

En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor

  • Mario W. Kramer
  • Jens J. Rassweiler
  • Jan Klein
  • Alexey Martov
  • Nikolay Baykov
  • Lukas Lusuardi
  • Günter Janetschek
  • Rodolfo Hurle
  • Mathias Wolters
  • Mahmoud Abbas
  • Christoph A. von Klot
  • Armin Leitenberger
  • Markus Riedl
  • Udo Nagele
  • Axel S. Merseburger
  • Markus A. Kuczyk
  • Marko Babjuk
  • Thomas R. W. Herrmann
Original Article

Abstract

Purpose

En bloc resection of bladder tumors (ERBT) may improve staging quality and perioperative morbidity and influence tumor recurrence. This study was designed to evaluate the safety, efficacy, and recurrence rates of electrical versus laser en bloc resection of bladder tumors.

Methods

This European multicenter study included 221 patients at six academic hospitals. Transurethral ERBT was performed with monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative parameters, and 12-month follow-up data was analyzed.

Results

Electrical and laser ERBT were used to treat 156 and 65 patients, respectively. Median tumor size was 2.1 cm; largest tumor was 5 cm. Detrusor muscle was present in 97.3 %. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3 vs. 1.5 %, p < 0.001). Median operation duration (25 min), postoperative irrigation (1 day), catheterization time (2 days), and hospitalization (3 days) were similar. Overall complication rate was low (Clavien ≥ 3, n = 6 [2.7 %]). Hemoglobin was significantly lower after electrical ERBT (p = 0.0013); however, overall hemoglobin loss was not clinically relevant (0.38 g/dl). Patients (n = 148) were followed for 12 months; 33 (22.3 %) had recurrences. In total, 63.6 % recurrences occurred outside the ERBT resection field. No difference was noted between ERBT groups.

Conclusions

ERBT is safe and reliable regardless of the energy source and provides high-quality resections of tumors >1 cm. Recurrence rates did not differ between groups, and the majority of recurrences occurred outside the ERBT resection field.

Keywords

Bladder cancer En bloc Holmium Laser Thulium TURBT 

Notes

Acknowledgments

We thank Jörg Weber for his support in establishing ERBT at the Hospital of Wolfsburg, Germany. We thank Mr. Abdul-Rahman Kabbani for his support in data collection.

Ethical standard

The study has been approved by the ethics committee of Hannover Medical School.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Mario W. Kramer
    • 1
  • Jens J. Rassweiler
    • 2
  • Jan Klein
    • 2
  • Alexey Martov
    • 3
  • Nikolay Baykov
    • 3
  • Lukas Lusuardi
    • 4
  • Günter Janetschek
    • 4
  • Rodolfo Hurle
    • 5
  • Mathias Wolters
    • 1
  • Mahmoud Abbas
    • 6
  • Christoph A. von Klot
    • 1
  • Armin Leitenberger
    • 7
  • Markus Riedl
    • 7
  • Udo Nagele
    • 8
  • Axel S. Merseburger
    • 1
  • Markus A. Kuczyk
    • 1
  • Marko Babjuk
    • 9
  • Thomas R. W. Herrmann
    • 1
  1. 1.Department of Urology and Urological OncologyHannover Medical SchoolHannoverGermany
  2. 2.Department of UrologySLK Kliniken HeilbronnHeilbronnGermany
  3. 3.Department of UrologyRussian Medical Postgraduate AcademyMoscowRussia
  4. 4.Department of UrologyMedical University SalzburgSalzburgAustria
  5. 5.Department of UrologyHumanitas Research HospitalMilanItaly
  6. 6.Institute of PathologyHannover Medical SchoolHannoverGermany
  7. 7.Department of UrologyHospital of WolfsburgWolfsburgGermany
  8. 8.Department of Urology and AndrologyTILAK General Hospital HallHall in TyrolAustria
  9. 9.Department of Urology, Hospital Motol, Second Faculty of MedicineCharles UniversityPragueCzech Republic

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