title: Novel green-light KTP laser en bloc enucleation for nonmuscle-invasive bladder cancer: technique and initial clinical experience.
abstract: OBJECTIVE
  The standard procedure for staging and treating nonmuscle-invasive bladder cancer (NMIBC) is still transurethral resection of bladder tumor (TURBT) via a wire loop. However, TURBT is associated with serious disadvantages that facilitate tumor recurrence. Recently, lasers have been explored as treatment tools for bladder tumors. Here, we report a novel tumor en bloc enucleation using a front-firing green-light potassium-titanyl-phosphate laser and its initial clinical application.
  
  
  METHODS
  From March through June 2013, 45 patients with NMIBC received modified transurethral resection using a front-firing green-light laser. En bloc enucleation was performed on all tumors. Preoperative and intraoperative data were retrospectively collected.
  
  
  RESULTS
  All patients successfully went through a session of treatment with front-firing green-light laser enucleation of the bladder tumor. Complications such as bladder hemorrhage, vesicle perforation, and obturator nerve reflex were not encountered during the treatment. The tumor diameter ranges from 0.3 to 3.0 cm with a mean value of 1.8 cm. Mean operative time and enucleation time were 21 (12-38) and 12 (4-23) minutes, respectively. Serum hemoglobin decreased 1.1 (0.1-2.4) mg/dL averagely. Mean catheter time was 2.0 (1.0-3.0) days, and mean postoperative hospital stay was 2.5 (1.5-4.0) days. The stages of bladder cancer included 27 Ta, 15 T1, and 3 T2a. No tumor recurrence was observed at the initial 6-month follow-up.
  
  
  CONCLUSIONS
  The modified technique using a front-firing green-light laser to en bloc enucleate bladder tumors is effective and safe for treatment of NMIBC. Moreover, it may improve the accurate valuation of tumor stage and prediction of postoperative prognosis, although long-term outcomes and prospective clinical trials are needed.
authors.affiliation: 1 Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University , Xi'an, P.R. China .
authors.forename: Dalin
authors.initials: D
authors.lastname: He
authors.forename: Jinhai
authors.initials: J
authors.lastname: Fan
authors.forename: Kaijie
authors.initials: K
authors.lastname: Wu
authors.forename: Xinyang
authors.initials: X
authors.lastname: Wang
authors.forename: Dapeng
authors.initials: D
authors.lastname: Wu
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.forename: Xudong
authors.initials: X
authors.lastname: Li
authors.forename: Lixia
authors.initials: L
authors.lastname: Liu
authors.forename: Peilong
authors.initials: P
authors.lastname: Cao
authors.forename: Jianwei
authors.initials: J
authors.lastname: Cao
authors.forename: Luke S
authors.initials: LS
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*