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A 10-year renaissance of en bloc resection of bladder tumors (ERBT): Are we approaching the peak or is it back to the trough?

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Abstract

Background

The number of studies suggesting that en bloc resection of bladder tumor (ERBT) is superior to transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) management is growing. The aim of this review is to discuss the features of these procedures and to determine the prospects of en bloc in NMIBC management.

Materials and methods

We conducted a literature search using two databases (Medline and Scopus) and included any research which reported ERBT outcomes.

Results

The lasers with minimal tissue penetration depth are becoming the main tool for ERBT. Unfortunately, most of the systematic reviews continue to be characterized by high heterogeneity. However, recent studies indicate that ERBT may have the edge when it comes to the detrusor muscle rate and the quality of the histological specimen. ERBT may favor in terms of in-field relapse, but its rate in the studies varies greatly. As for out-field relapse-free survival, the data are still lacking. The strongest evidence supports that ERBT is superior to TURBT in complications rate (bladder perforation). ERBT is feasible irrespective to tumor size and location.

Conclusions

ERBT has gained in momentum with the increasingly widespread use of this kind of laser surgery. The introduction of novel sources (TFL and Thulium:YAG pulsed laser) will definitely affect how the field develops and will result in further improvements in safety and precision. The latest trials make us more certain in our belief that ERBT will be beneficial in terms of histological specimen quality, relapse rate and complications rate.

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The authors confirm that the data supporting the findings of this study are available within the article.

Abbreviations

TURBT:

Transurethral resection of bladder tumor

ERBT:

En bloc resection of bladder tumor

TFL:

Thulium fiber laser

NMIBC:

Non-muscle-invasive bladder cancer

EAU:

European Association of Urology

RFS:

Recurrence-free survival

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Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Dmitry Enikeev & Harun Fajkovic

  2. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Dmitry Enikeev, Andrey Morozov & Anastasia Shpikina

  3. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Dmitry Enikeev & Harun Fajkovic

  4. Division of Urology, Rabin Medical Center, Petach Tikva, Israel

    Jack Baniel

  5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Jack Baniel

  6. Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  7. Department of Urology, Stellenbosch University, Western Cape, South Africa

    Thomas R. W. Herrmann

  8. Hannover Medical School, MHH Carl Neuberg Str. 1, 30625, Hannover, Germany

    Thomas R. W. Herrmann

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  1. Dmitry Enikeev
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Enikeev, D., Morozov, A., Shpikina, A. et al. A 10-year renaissance of en bloc resection of bladder tumors (ERBT): Are we approaching the peak or is it back to the trough?. World J Urol 41, 2607–2615 (2023). https://doi.org/10.1007/s00345-023-04439-3

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