Safety & efficacy of thulium laser endoscopic en bloc resection versus conventional trans urethral resection of bladder tumors, for treatment of non muscle invasive bladder tumors: A prospective randomized trial.

Introduction: Non-muscle invasive bladder cancers (NMIBCs) are managed with endoscopic resection and intravesical therapy. Lasers, particularly thulium and holmium, are now central to bladder tumor management. This study assesses the safety and efficacy of thulium laser enucleation of bladder tumors (Tm-LRBT).

Patients & methods: A prospective randomized clinical study was conducted from June 2022 to December 2023, involving 100 patients. Group A was treated with TmLRBT and Group B with conventional monopolar TURBT. Informed consent was obtained from all participants. Inclusion criteria were NMIBC, tumor size < 5 cm, and fewer than three tumors. Exclusion criteria included tumors > 5 cm, more than three tumors, invasive/upper tract cancers, hydronephrosis, metastases, and history of TURBT.

Results: The mean tumor diameter in Group A was 2.3 ± 0.74 cm. The mean operative time was 45.4 ± 13.48 minutes. Re-resection within 90 days was negative for bladder cancer in all Group A patients; three patients in Group B had persistent disease. Seven Group B cases lacked muscle in the specimen compared to three in Group A. Significant intraoperative bleeding occurred in four cases in Group A and five in Group B. Tumor recurrence was 42% in Group A and 44% in Group B at 12-month follow-up. .

Conclusion: TmLRBT is a potential alternative to TURBT, providing accurate reporting of neoplastic depth invasion. It is advantageous, particularly for tumors in the lateral wall, bladder dome, or perimeatal zone.