title: Thulium:yttrium-aluminum-garnet laser for en bloc resection of bladder cancer: clinical and histopathologic advantages.
abstract: OBJECTIVE
  To determine whether thulium:yttrium-aluminum-garnet laser resection of bladder tumor (TmLRBT) may offer advantages over classic resection.
  
  
  METHODS
  From April 2011 to September 2012, 55 consecutive patients newly diagnosed with clinical stage ≤T2 bladder cancer were enrolled in a prospective study on TmLRBT. Neoplasm was removed en bloc in all cases. When the tumor size was >3 cm, it was necessary to incise longitudinally and/or across the lesion and the bladder wall at its the base into 2 or more parts. All cases of non-muscle-invasive bladder cancer underwent second look in 30-90 days.
  
  
  RESULTS
  Pathology reported urothelial carcinoma with Ta low grade in 31 patients (56.4%), T1 high grade in 18 (32.7%), and T2 high grade in 6 (10.9%). Histopathologic evaluation showed that the bladder detrusor was provided in all cases. Hemostasis was excellent, and no postoperative hematuria was reported. In a case of T1 G3, endoscopic re-evaluation showed a focal infiltration of the bladder detrusor, so the patient underwent radical cystectomy. To date, with a mean follow-up of 16 months (range, 8-25), the recurrence rate in patients with superficial disease is 14.5%. All recurrences were outside the site of first resection, and there was no progression in tumor grade.
  
  
  CONCLUSIONS
  TmLRBT is a simple method that seems to overcome the "incise and scatter" problem associated with traditional transurethral resection of bladder tumor. Our initial data on staging accuracy and reduction of the local recurrence rate are encouraging.
authors.affiliation: Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muto
authors.affiliation: Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
authors.forename: Devis
authors.initials: D
authors.lastname: Collura
authors.affiliation: Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacobbe
authors.affiliation: Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: D'Urso
authors.affiliation: University Campus Biomedico, Rome, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Muto
authors.affiliation: Department of Pathological Anatomy, San Giovanni Bosco Hospital, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Demarchi
authors.affiliation: Department of Pathological Anatomy, San Giovanni Bosco Hospital, Turin, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Coverlizza
authors.affiliation: Department of Urology, San Giovanni Bosco Hospital, Turin, Italy. Electronic address: castelli2006@hotmail.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Castelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000535:Aluminum / Q000737:chemistry*; D015653:Cystectomy / Q000379:methods; D018450:Disease Progression; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013932:Thulium / Q000737:chemistry*; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery / Q000628:therapy*; D015019:Yttrium / Q000737:chemistry*
chemical_list: C503779:yttrium-aluminum-garnet; D015019:Yttrium; D013932:Thulium; D000535:Aluminum