Category: Clinical Oncology: Outcomes & Complications

MP30-20 - The efficiency of Nd:YAG laser coagulation in the treatment of non-muscle invasive bladder cancer

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

One of the most promising areas of surgery in general and of oncourology in particular, is the use of laser technology. Transurethral bladder resection  (TURB) allows to specify the degree of invasion, however TURB has several disadvantages, one of which is a high rate of local recurrence (Brausi M. et al., 2002). There are few data in the literature on the effectiveness of TURB in combination with laser coagulation of the bladder tumor bed (Smith N. et al., 2010; Babjuk M. et al. , 2009).


Objective: to evaluate the efficiency of Nd:YAG laser coagulation after TURB in patients with superficial bladder cancer.


Methods : From 2007 to 2017 216 patients (main group) with Ta (24 – 11,1%) and T1 (192 – 88,9%) (26-84 y.o.) were underwent Nd:YAG laser coagulation of the bladder tumor bed after TURB and 55 patients (control group)  with Ta (7 – 12,7%) and T1 (48 – 87,3%) were underwent only TURB. Tumors size ranged from 3 mm to 30 mm (average 12 mm). At the first year of study the control cystoscopy were performed every three month. The proposed method consisted of two stages: a mono- or bipolar TURB with a tumor, and laser coagulation of the bed of the removed tumor with surrounding tissues by pulse-periodic Nd:YAG laser (1064 nm) in free running mode with  (“Lasurit” Laser Surgery System) delivered through a 600 micron bare fiber.  The distance from the surface 2-3 mm, 100Hz repetition rate, output radiation power 34-48W. The coagulation time was directly proportional to the size of the tumor bed. In both groups after surgery, all patients received  immediate single intravesical instillation of chemotherapy. At the first year of study the control cystoscopy were performed every three months.


Results : Analysis of the results of treatment showed that in the first group (TURB+Laser) local recurrence during the whole follow-up period of observation was reported in 1.9% and after standard transurethral resection - in 16.4% of cases. Hematuria after TURB was observed in 2.5 times more frequently than in patients from the first group. The postoperative bed-day in the main group was 1 day shorter than in the control group. Any complications did not occur.


Conclusions : Thus, Nd:YAG laser coagulation of the tumor bed after TURB of non-muscle invasive bladder cancer can significantly reduce the number of local relapses. The proposed method is effective and safe in the treatment of non-muscle invasive bladder cancer.

Stanislav Naryshkin

Head of Endourology & ESWL Division
Scientific and Clinical Center of JSC Russian Railways
Moscow, Moskva, Russia

Oleg Teodorovich

Head of Endoscopic Urology Department
Endoscopic Urology Department, Russian Medical Academy of Continuous Professional Education
Moscow, Moskva, Russia

Maxsim Shatokhin

Professor
Endoscopic Urology Department, Russian Medical Academy of Continuous Professional Education
Moscow, Moskva, Russia

Gennady Borisenko

Associate Professor
Endoscopic Urology Department, Russian Medical Academy of Continuous Professional Education
Moscow, Moskva, Russia

David Kochiev

Deputy Director for Science
Prokhorov General Physics Institute, Russian Academy of Sciences
Moscow, Moskva, Russia

Ahmed Dudarov

Urologist
Endoscopic Urology Department, Russian Medical Academy of Continuous Professional Education
Moscow, Moskva, Russia