Novel diagnostic and screening methods currently allow detecting bladder cancer at early stages (Tis-T1N0M0) which means that the patient can be managed with a less invasive technique – laser en-bloc enucleation with photodynamic diagnosis (PDD). This method provides an opportunity for complete cancer removal, avoiding complications and obtaining the best samples for histopathology.
Our retrospective study included 69 patients (46 males and 23 females) aged 60.1 (22-81) years with bladder tumor (Ta, Tis, T1N0M0). All the patients underwent thulium laser en-bloc enucleation of bladder tumor. A total of 79 en-bloc enucleations were performed. Tumor size ranged from 0.5 to 6 cm. For enucleation, we used Urolase (NTO IRE-POLUS, Russia), a 120 W thulium fiber laser, and a 600 µm fiber. The EORTC bladder calculator was used for risk assessment. In 60 cases it was intermediate and in 9 cases – high. Follow-up lasted for 6-12 months.
Mean surgery time was 43.4 min. All surgeries were uneventful with no cases of intraoperative bladder damage. Following surgery, all the patients underwent 1 hour long intravesical therapy with 40 mg of Mitomycin C. In 75 (94.9%) cases, histopathology revealed muscle tissue. Mean catheterization time was 22.5 hours. Mean hospital stay was 2.9 days. No postoperative complications exceeding grade I on the Clavien-Dindo scale were observed. In 12 months after surgery, relapse was noted in 8 (11.6%) patients.
Thulium Fiber laser en-bloc enucleation of the bladder tumor with PDD is a safe treatment option for early-stage prostate cancer (Ta, Tis, T1N0M0). PDD allows for better control over the surgery site ultimately decreasing the risk of relapse. The technique offers a possibility of obtaining better samples for subsequent histopathology thus giving the option of adjusting personalized treatment in each case of bladder cancer.