BERKELEY, CA (UroToday.com) - The incidence of bladder cancer has shown an increase over the past decades.
Causal factors include an increase of smoking prevalence and less stringent rules on occupational safety to chemicals in developing countries. A rising problem in industrialized countries is an aging population which leads to a higher degree on perioperative surgical challenges as more and more patients are prescribed permanent anticoagulants. From a surgeon’s point of view, surgical enhancements leading to a decrease in peri- and postoperative morbidity as well as providing better oncological outcomes contribute to a constant striving of alternative methods.
These and other factors have resulted in the development of laser therapies for urinary bladder cancer. Today, two lasers are mainly applied on carcinomas of the bladder: Holmium laser (Holmium:Yttrium Aluminum Garnet, Ho:YAG) and Thulium laser (Thulium:Yttrium Alluminum Garnet; Tm:YAG). While Ho:YAG has been part of the armamentum of many urologists since the 1990s, Tm:YAG was recruited into clinical practice in 2005. Due to the slightly shorter wavelength compared to Ho:YAG, the depth of penetration is decreased and the continuous wave output of Tm:YAG allows smoother incision and vaporisation of tissue with excellent haemostasis. While first reports focused on imitating the “incise and scatter” resection technique that is used by TURB, later authors concentrated on en bloc resection methods. The latter potentially limits the amount of tissue scattering and allows for the preservation of the entire histological structures, especially on the edges of the specimen. Using en bloc resection, the rate of recurrence has been decreased and the quality of life of treated patients has been improved.
In general the resection or vaporization of bladder tumors using holmium laser has been described as feasible with acceptable surgical duration with minimal complication rates. This method has been performed in an outpatient setting, thus avoiding hospitalization and decreasing overall treatment costs. Facts on recurrence and / or progression are rather limited but might be, based on available data, similar or even lower compared to conventional TURB. Reports on Tm:YAG are even more limited, however they underline the possibility of en bloc resection methods with neglectible complication rates.
Although fewer published articles on laser methods are available in comparison to conventional TURB, the results, especially of the few prospective randomized head-to-head studies, implies at least equal potential for the two laser therapies. It is not clear yet if en bloc resection methods reduce the risk of recurrence as it has been described as a possible advantage. Further prospective, randomized studies with long-term follow-up are needed to point out whether the hypothetical benefit of laser treatment on bladder cancer is consistent with the currently available literature and may be applied as an equivalent alternative to conventional TURB.
Mario W. Kramer, Mathias Wolters and Thomas R. W. Herrmann as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.