Transurethral partial cystectomy with 2 μm thulium continuous wave laser in the treatment of bladder pheochromocytoma.
OBJECTIVE
To introduce transurethal partial cystectomy with a 2013 nm thulium laser as a treatment for paraganglioma of the urinary bladder in adults.


METHODS
Three patients with pheochromocytomas were treated transurethrally with a 2013 nm thulium laser under general anesthesia. A 2013 nm thulium laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together. Intraoperative fluctuation of blood pressure, preoperative values of 24-hour urine catecholamine (CA) and vanillylmandelic acid (VMA), and postoperative complications were observed, and postoperative followtwoups were performed.


RESULTS
All operations were successful. Operative time was 25 to 32 minutes. Perioperative blood pressure was stable in two cases while blood pressure fluctuated in the third case. When the entire tumor and the full-thickness bladder wall at the base were freed, blood pressure reverted to stability. All values of 24-hour urine CA and VMA were within normal limits postoperatively. Patients were followed for 7 to 9 months postoperatively with no recurrence. This series included highly selected patients who were treated by a single senior surgeon who is rich in experience in performing 2013 nm thulium laser procedures.


CONCLUSIONS
To our knowledge, this is the first report of a 2013 nm thulium laser used to treat bladder pheochromocytoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and cut down the blood supply of the tumor, then peel it while blood pressure remains stable, thus completing partial cystectomy for bladder pheochromocytoma safely.
Department of Urology, PLA General Hospital, Beijing, China. yongyang301@yahoo.com
Yong
Y
Yang
Zhi-tao
ZT
Wei
Jin-shan
JS
Lu
Qiang
Q
Zu
Haiyi
H
Wang
Xu
X
Zhang
D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D001794:Blood Pressure; D003287:Contrast Media; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care; D053685:Laser Therapy / Q000379:methods*; D007834:Lasers; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013932:Thulium / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
D003287:Contrast Media; D013932:Thulium