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En-bloc-Resektion und Vaporisation von Harnblasenkarzinomen

En bloc resection and vaporization techniques for the treatment of bladder cancer

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Zusammenfassung

Hintergrund

Modifikationen in der endourologischen Therapie von Harnblasentumoren haben das Ziel, bekannte Schwächen der konventionellen transurethralen Resektionstechnik (z. B. Tumorfragmentierung) zu verbessern (En-bloc-Resektion, ERBT) oder den allgemeinen Behandlungsrhythmus zu vereinfachen (Vaporisation).

Ziel der Arbeit

Die vorliegende Übersichtsarbeit präsentiert die aktuelle Datenlage im Hinblick auf die verwendeten Techniken, die zu erwartende histopathologische Qualität der Präparate, die perioperativen Komplikationen und das onkologische Ergebnis.

Material und Methoden

Sowohl für die ERBT als auch für die Vaporisation erfolgten jeweils separate Datenrecherchen. Zum Thema ERBT wurden 27 und zum Thema Vaporisation 15 Artikel identifiziert.

Ergebnisse

Zumeist wird die ERBT durch eine zirkumferentielle Inzision in die Mukosa durchgeführt. Alternativ kann der Tumor von vorne unterminierend enukleiert werden. Die Resektionsqualität lässt sich anhand höherer Detrusornachweisraten (90–100 %) verbessern. Relevante Unterschiede zur konventionellen transurethralen Resektion der Harnblase (TURB) im Hinblick auf die perioperative Komplikationsrate wurden nicht nachgewiesen, allenfalls eine verringerte Rate einer N. obturatorius bedingten Blasenperforation bei der Laser-ERBT. Hinsichtlich der Rezidivraten zeigt sich ein statistisch nicht signifikanter Trend zugunsten der ERBT. Vaporisationen eignen sich für Patienten mit niedriger Risikokonstellation in der primären TURB. Sie können unter Anwendung von Lokalanästhetika ambulant und ohne Narkose durchgeführt werden.

Schlussfolgerung

Die ERBT zeigt vielversprechende Ergebnisse im Hinblick auf die Verbesserung der histopathologischen Auswertbarkeit. Die Umsetzung der Vaporisation als flächendeckend eingesetzte Methodik scheitert derzeit am deutschen Vergütungssystem.

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.

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Literatur

  1. Abotaleb AA, Kandeel WS, Elmohamady B et al (2017) Bipolar plasma kinetic enucleation of non-muscle-invasive bladder cancer: Initial experience with a novel technique. Arab J Urol 15:355–359

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chen X, Liao J, Chen L et al (2015) Erratum to: En bloc transurethral resection with 2‑micron continuous-wave laser for primary non-muscle-invasive bladder cancer: a randomized controlled trial. World J Urol 33(7):997. https://doi.org/10.1007/s00345-014-1357-7

    Article  PubMed  Google Scholar 

  3. Cheng B, Qiu X, Li H et al (2017) The safety and efficacy of front-firing green-light laser endoscopic en bloc photoselective vapo-enucleation of non-muscle-invasive bladder cancer. Ther Clin Risk Manag 13:983–988

    Article  PubMed  PubMed Central  Google Scholar 

  4. D’souza N, Verma A (2016) Holmium laser transurethral resection of bladder tumor: our experience. Urol Ann 8:439–443

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fontana G, Governa N, Aimé G, Polledro P, Ambruoso G, Cordara G, Borsa R (1997) Transurethral tissue vaporization: indications and limitations of the technique. Our experience in 105 cases. Minerva Urol Nefrol 49(3):173–177

    PubMed  CAS  Google Scholar 

  6. Fritsche H-M, Otto W, Eder F, et al. Water-jet-aided transurethral dissection of urothelial carcinoma: A prospective clinical study. J Endourol 25(10):1599–603. https://doi.org/10.1089/end.2011.0042

    Article  PubMed  Google Scholar 

  7. 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. https://doi.org/10.1111/j.1464-410X.2008.07814.x

    Article  PubMed  Google Scholar 

  8. Geavlete B1, Multescu R, Georgescu D, Stanescu F, Jecu M, Geavlete P (2012) Narrow band imaging cystoscopy and bipolar plasma vaporization for large nonmuscle-invasive bladder tumors–results of a prospective, randomized comparison to the standard approach. Urology 79(4):846–851. https://doi.org/10.1016/j.urology.2011.08.081

    Article  PubMed  Google Scholar 

  9. He D, Fan J, Wu K, Wang X, Wu D, Li L, Li X, Liu L, Cao P, Cao J, Chang LS (2014) Novel green-light KTP laser en bloc enucleation for nonmuscle-invasive bladder cancer: technique and initial clinical experience. J Endourol 28(8):975–979. https://doi.org/10.1089/end.2013.0740

    Article  PubMed  Google Scholar 

  10. Herr HW, Donat SM (2008) Quality control in transurethral resection of bladder tumours. BJU Int 102:1242–1246

    Article  PubMed  Google Scholar 

  11. Herrmann TR, Wolters M, Kramer MW (2017) Transurethral en bloc resection of nonmuscle invasive bladder cancer: trend or hype. Curr Opin Urol 27:182–190

    Article  PubMed  Google Scholar 

  12. Hossain MZ, Khan SA, Salam MA, Hossain S, Islam R (2005) Holmium YAG laser treatment of superficial bladder carcinoma. Mymensingh Med J 14(1):13–15

    PubMed  CAS  Google Scholar 

  13. Hurle R, Lazzeri M, Colombo P et al (2016) “En bloc” resection of nonmuscle invasive bladder cancer: a prospective single-center study. Urology 90:126–130

    Article  PubMed  Google Scholar 

  14. Johnson DE (1994) Use of the holmium:YAG (Ho:YAG) laser for treatment of superficial bladder carcinoma. Lasers Surg Med 14(3):213–218

    Article  PubMed  CAS  Google Scholar 

  15. Jonler M, Lund L, Bisballe S (2004) Holmium:YAG laser vaporization of recurrent papillary tumours of the bladder under local anaesthesia. BJU Int 94:322–325

    Article  PubMed  Google Scholar 

  16. Kramer MW, Rassweiler JJ, Klein J et al (2015) 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. World J Urol 33(12):1937–1943. https://doi.org/10.1007/s00345-015-1568-6

    Article  PubMed  Google Scholar 

  17. Kramer MW, Wolters M, Cash H et al (2015) Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014. World J Urol 33:571–579

    Article  PubMed  CAS  Google Scholar 

  18. Kramer MW, Altieri V, Hurle R et al (2017) Current evidence of transurethral en-bloc resection of nonmuscle invasive bladder cancer. Eur Urol Focus. https://doi.org/10.1016/j.euf.2016.12.004

    Article  PubMed  Google Scholar 

  19. Li Z, Hou R, Li J (2014) The efficacy and safety of simultaneous transurethral GreenLight photoselective vaporization of bladder tumor and prostate in patients with bladder tumor and lower urinary tract symptoms. Int Urol Nephrol 46(4):691–694. https://doi.org/10.1007/s11255-013-0572-2

    Article  PubMed  Google Scholar 

  20. Liu H, Wu J, Xue S et al (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 41:984–992

    Article  PubMed  CAS  Google Scholar 

  21. Lodde M, Lusuardi L, Palermo S, Signorello D, Maier K, Hohenfellner R, Pycha A (2003) En bloc transurethral resection of bladder tumors: use and limits. Urology 62(6):1089–1091. https://doi.org/10.1016/S0090-4295(03)00761-1

    Article  PubMed  Google Scholar 

  22. Mariappan P, Zachou A, Grigor KM (2010) Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol 57:843–849

    Article  PubMed  Google Scholar 

  23. Maurice MJ, Vricella GJ, MacLennan G, Buehner P, Ponsky L (2012) Endoscopic Snare Resection of Bladder Tumors: Evaluation of an Alternative Technique for Bladder Tumor Resection. J Endourology/Endourological Society 26(6):614–617. https://doi.org/10.1089/end.2011.0587

    Article  Google Scholar 

  24. Migliari R, Buffardi A, Ghabin H (2015) Thulium laser endoscopic en bloc enucleation of nonmuscle-invasive bladder cancer. J Endourol 29:1258–1262

    Article  PubMed  Google Scholar 

  25. Muto G, Collura D, Giacobbe A et al (2014) Thulium:yttrium-aluminum-garnet laser for en bloc resection of bladder cancer: clinical and histopathologic advantages. Urology 83:851–855

    Article  PubMed  Google Scholar 

  26. Nagele U, Kugler M, Nicklas A, Merseburger AS, Walcher U, Mikuz G, Herrmann TR (2011) Waterjet hydrodissection: first experiences and short-term outcomes of a novel approach to bladder tumor resection. World J Urol 29(4):423–427. https://doi.org/10.1007/s00345-011-0653-8

    Article  PubMed  CAS  Google Scholar 

  27. Naselli A, Introini C, Germinale F et al (2012) En bloc transurethral resection of bladder lesions: a trick to retrieve specimens up to 4.5 cm. BJU Int 109:960–963

    Article  PubMed  Google Scholar 

  28. Razvi HA, Chun SS, Denstedt JD, Sales JL (1995) Soft-Tissue Applications of the Holmium:YAG Laser in Urology. J Endourology. https://doi.org/10.1089/end.1995.9.387

    Article  Google Scholar 

  29. Saito S (2001) Transurethral en bloc resection of bladder tumors. J Urol 166:2148–2150

    PubMed  CAS  Google Scholar 

  30. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. Ca Cancer J Clin 66:7–30

    Article  PubMed  Google Scholar 

  31. Soler-Martínez J, Vozmediano-Chicharro R, Morales-Jiménez P, Hernández-Alcaraz D, Vivas-Vargas E, García-Vaquero IS, Baena-González V (2007) Holmium Laser Treatment for Low Grade, Low Stage, Noninvasive Bladder Cancer With Local Anesthesia and Early Instillation of Mitomycin C. Urology 178(6):2337–2339. https://doi.org/10.1016/j.juro.2007.08.034

    Article  Google Scholar 

  32. Struck JP, Kramer MW, Merseburger AS et al (2017) En-bloc resection of bladder tumours (ERBT): current and future perspectives. Aktuelle Urol 48:306–313

    Article  PubMed  CAS  Google Scholar 

  33. Sureka SK, Agarwal V, Agnihotri S, Kapoor R, Srivastava A, Mandhani A (2014) Is en-bloc transurethral resection of bladder tumor for non-muscle invasive bladder carcinoma better than conventional technique in terms of recurrence and progression?: A prospective study. Indian J Urol 30(2):144–149. https://doi.org/10.4103/0970-1591.126887

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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

    Article  PubMed  CAS  Google Scholar 

  35. 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. https://doi.org/10.1089/end.2012.0696

    Article  PubMed  Google Scholar 

  36. Tao W, Yang D, Shan Y, Xue B, Sun C, Zang Y, Zhang Y (2013) Safety and efficacy of 120W high performance system greenlight laser vaporization for non-muscle-invasive bladder cancer. J Xray Sci Technol 21(2):309–316. https://doi.org/10.3233/XST-130379

    Article  PubMed  Google Scholar 

  37. Ukai R, Kawashita E, Ikeda H (2000) A new technique for transurethral resection of superficial bladder tumor in 1 piece. J Urol 163(3):878–879. https://doi.org/10.1016/S0022-5347(05)67824-X

    Article  PubMed  CAS  Google Scholar 

  38. Ukai R, Hashimoto K, Iwasa T, Nakayama H (2010) Transurethral resection in one piece (TURBO) is an accurate tool for pathological staging of bladder tumor. Int J Urol 17(8):708–714. https://doi.org/10.1111/j.1442-2042.2010.02571.x

    Article  PubMed  Google Scholar 

  39. Upadhyay R, Kapoor R, Srivastava A et al (2012) Does en-bloc transurethral resection of bladder tumor give a better yield in terms of presence of detrusor muscle in the biopsy specimen? Indian J Urol 28:275–279

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wolters M, Kramer MW, Becker JU et al (2011) Tm:YAG laser en bloc mucosectomy for accurate staging of primary bladder cancer: early experience. World J Urol 29:429–432

    Article  PubMed  Google Scholar 

  41. 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? Urological Oncology 112(5):561–567. https://doi.org/10.1111/bju.12216

    Article  Google Scholar 

  42. Wu YP, Lin TT, Chen SH et al (2016) Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor: A meta-analysis. Medicine (Baltimore) 95:e5372

    Article  Google Scholar 

  43. Xishuang S, Deyong Y, Xiangyu C et al (2010) Comparing the safety and efficiency of conventional monopolar, plasmakinetic, and holmium laser transurethral resection of primary non-muscle invasive bladder cancer. J Endourol 24:69–73

    Article  PubMed  Google Scholar 

  44. Xu H, Ma J, Chen Z et al (2018) Safety and efficacy of en bloc transurethral resection with 1.9 microm vela laser for treatment of non-muscle-invasive bladder cancer. Urology 113:246–250. https://doi.org/10.1016/j.urology.2017.11.030

    Article  PubMed  Google Scholar 

  45. Xu Y, Guan W, Chen W et al (2015) Comparing the treatment outcomes of potassium-titanyl-phosphate laser vaporization and transurethral electroresection for primary nonmuscle-invasive bladder cancer: a prospective, randomized study. Lasers Surg Med 47:306–311

    Article  PubMed  Google Scholar 

  46. Yang Y, Wei Z, Lu J et al (2012) Transurethral partial cystectomy with 2 µm thulium continuous wave laser in the treatment of bladder pheochromocytoma. J Endourol 26(6):686–690

    Article  PubMed  Google Scholar 

  47. Yang D, Xue B, Zang Y et al (2014) Efficacy and safety of potassium-titanyl-phosphate laser vaporization for clinically non-muscle invasive bladder cancer. Urol J 11:1258–1263

    PubMed  Google Scholar 

  48. Zhang K-Y, Xing J-C, Li W, Wu Z, Chen B, Bai D-Y (2017) A novel transurethral resection technique for superficial bladder tumor: retrograde en bloc resection. World J Surg Oncol 15:125. https://doi.org/10.1186/s12957-017-1192-6

    Article  PubMed  PubMed Central  Google Scholar 

  49. Zhang XR, Feng C, Zhu WD et al (2015) Two micrometer continuous-wave thulium laser treating primary non-muscle-invasive bladder cancer: is it feasible? A randomized prospective study. Photomed Laser Surg 33:517–523

    Article  PubMed  CAS  Google Scholar 

  50. Zhang Z, Zeng S, Zhao J et al (2017) A pilot study of vela laser for en bloc resection of papillary bladder cancer. Clin Genitourin Cancer 15:e311–e314

    Article  PubMed  Google Scholar 

  51. 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. https://doi.org/10.1007/s00345-010-0532-8

    Article  PubMed  Google Scholar 

  52. Zhu Y, Jiang X, Zhang J et al (2008) Safety and efficacy of holmium laser resection for primary nonmuscle-invasive bladder cancer versus transurethral electroresection: single-center experience. Urology 72:608–612

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    J. P. Struck &  M. W. Kramer

  2. Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    A. Karl

  3. Urologische Klinik, Diakonie Klinikum Stuttgart, Stuttgart, Deutschland

    C. Schwentner

  4. Klinik für Urologie, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Schweiz

    T. R. W. Herrmann

  5. Klinik für Urologie und Uro-Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    T. R. W. Herrmann

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  1. J. P. Struck
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  2. A. Karl
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  3. C. Schwentner
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  4. T. R. W. Herrmann
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  5. M. W. Kramer
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Correspondence to M. W. Kramer.

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Interessenkonflikt

J.P. Struck, A. Karl, C. Schwentner, T.R.W. Herrmann und M.W. Kramer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Struck, J.P., Karl, A., Schwentner, C. et al. En-bloc-Resektion und Vaporisation von Harnblasenkarzinomen. Urologe 57, 665–672 (2018). https://doi.org/10.1007/s00120-018-0625-3

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