Muscle-noninvasive bladder cancer: treatment with a thulium laser in comparison with transurethral electrosection

Bladder cancer is one of the most common urological malignancies. Approximately 75-85% of newly diagnosed cases of bladder cancer are limited to the mucous membrane (Ta or Tis) or submucosa (T1) and are represented by non-muscle invasive bladder cancer (NMIBC). The gold standard for the treatment of patients with NMIBC is the most commonly used surgical procedure - transurethral electrosection of a bladder tumor (TURBT). However, this procedure can lead to serious complications, such as obturator nerve reflex, bladder perforation, stricture of the ureteral ostium, and post-operative bleeding especially in patients who take anticoagulants therapy. To overcome possible complications, other methods of treating MNRMP have recently become available, in particular, thulium laser resection of a bladder tumor (ThuLEP). Recent studies haveshown the effectiveness and safety of the ThuLEP method in the treatment of NMIBC. However, in most cases, ThuLEP was used for secondary treatment of patients with a confirmed pathological diagnosis.Objective: to evaluate the safety and effectiveness of ThuLEP compared with TURBT as the first method of treatment of NMIBC. Materials and methods. 158 patients with primary NMIBC were randomly assigned to two groups that were treated with ThuLEP or TURBT. Intraoperative and postoperative characteristics in the observation groups were compared. These characteristics included the data on the time of surgery, the development of the obturator nerve reaction, bladder perforation, bladder irrigation, catheterization time, hospital stay and 1-, 3-, 6-, 12-, and 18-month relapse-free survival. Results. There was no significant difference in the duration of the operation between the two groups. Compared with the TURBT group, patients in the ThuLEP group had fewer intraoperative and postoperative complications, including obturator syndrome, transient hematuria and postoperative dysuria. There were no significant differences between the two groups in the frequency of hemotransfusion and the frequency of urethral strictures. Patients in the ThuLEP group had a shorter duration of catheterization and hospitalization compared to patients in the TURBT group. There were no differences in the frequency of relapses among the groups of TURBT and ThuLEP. Conclusion. ThuLEP can be considered as a safe and effective method that has a number of advantages over TURBT. ThuLEP can be used as an alternative TURBT procedure in patients with NMIBC.