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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

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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.

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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.

Author information

Authors and Affiliations

  1. Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Mario W. Kramer, Mathias Wolters, Christoph A. von Klot, Axel S. Merseburger, Markus A. Kuczyk & Thomas R. W. Herrmann

  2. Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany

    Jens J. Rassweiler & Jan Klein

  3. Department of Urology, Russian Medical Postgraduate Academy, Moscow City Hospital No. 57, Moscow, Russia

    Alexey Martov & Nikolay Baykov

  4. Department of Urology, Medical University Salzburg, Salzburg, Austria

    Lukas Lusuardi & Günter Janetschek

  5. Department of Urology, Humanitas Research Hospital, Milan, Italy

    Rodolfo Hurle

  6. Institute of Pathology, Hannover Medical School, Hannover, Germany

    Mahmoud Abbas

  7. Department of Urology, Hospital of Wolfsburg, Wolfsburg, Germany

    Armin Leitenberger & Markus Riedl

  8. Department of Urology and Andrology, TILAK General Hospital Hall, Hall in Tyrol, Austria

    Udo Nagele

  9. Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Marko Babjuk

Authors
  1. Mario W. Kramer
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  15. Axel S. Merseburger
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Corresponding author

Correspondence to Thomas R. W. Herrmann.

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Kramer, M.W., Rassweiler, J.J., Klein, J. et al. 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, 1937–1943 (2015). https://doi.org/10.1007/s00345-015-1568-6

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  • DOI: https://doi.org/10.1007/s00345-015-1568-6

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