Thulium fiber laser en bloc resection for bladder tumour. Tips and tricks

INTRODUCTION AND OBJECTIVE: According to a number of guidelines, en bloc resection of bladder tumor has been considered standard procedure since 2018 along with conventional transurethral resection with electric loop. It may improve grading and even oncological outcomes due to the presence of the muscle layer. Moreover, piecemeal resection may lead to tumor re-implantation and relapse due to long contact with the bladder walls. However, despite its advantages, en bloc resection is considered to be a more difficult procedure. With this video we want to share our experience with en bloc and provide data on its outcomes. METHODS: We provide outcomes of 71 consecutive en bloc resections of bladder tumor with thulium fiber laser in the Institute for Urology and Reproductive Health, Sechenov University. A comparison group consisted of 58 consecutive monopolar TURBTs. All the procedures were recorded. RESULTS: In the video we address different aspects of the en bloc technique and provide step-by-step guidance. We also offer advice on how to successfully perform en bloc in case of tumor larger than 3 cm, or tumor invading the ureteric orifice. At 6 months, recurrence was detected in 19 patients after TURBT and in 6 patients after Tm fiber en bloc, OR 6.1 (95% CI 1.6 e 23.8, p[0.009). Univariate analysis also showed association between muscle layer presence and relapse rate, OR 4.63 (95% CI 1.1 e 19.4, p[0.36). CONCLUSIONS: With the presented videos we intend to highlight that en bloc is no more difficult than TURBT and it is applicable in different cases including large tumors. We believe this will help surgeons to master this technique. Our data suggest that en bloc offers improved oncological outcomes.