title: En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor.
abstract: OBJECTIVE
  En bloc resection of bladder tumors (ERBT) may improve staging quality and perioperative morbidity and influence tumor recurrence. This study was designed to evaluate the safety, efficacy, and recurrence rates of electrical versus laser en bloc resection of bladder tumors.
  
  
  METHODS
  This European multicenter study included 221 patients at six academic hospitals. Transurethral ERBT was performed with monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative parameters, and 12-month follow-up data was analyzed.
  
  
  RESULTS
  Electrical and laser ERBT were used to treat 156 and 65 patients, respectively. Median tumor size was 2.1 cm; largest tumor was 5 cm. Detrusor muscle was present in 97.3 %. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3 vs. 1.5 %, p < 0.001). Median operation duration (25 min), postoperative irrigation (1 day), catheterization time (2 days), and hospitalization (3 days) were similar. Overall complication rate was low (Clavien ≥ 3, n = 6 [2.7 %]). Hemoglobin was significantly lower after electrical ERBT (p = 0.0013); however, overall hemoglobin loss was not clinically relevant (0.38 g/dl). Patients (n = 148) were followed for 12 months; 33 (22.3 %) had recurrences. In total, 63.6 % recurrences occurred outside the ERBT resection field. No difference was noted between ERBT groups.
  
  
  CONCLUSIONS
  ERBT is safe and reliable regardless of the energy source and provides high-quality resections of tumors >1 cm. Recurrence rates did not differ between groups, and the majority of recurrences occurred outside the ERBT resection field.
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Mario W
authors.initials: MW
authors.lastname: Kramer
authors.affiliation: Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany.
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Rassweiler
authors.affiliation: Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.affiliation: Department of Urology, Russian Medical Postgraduate Academy, Moscow City Hospital No. 57, Moscow, Russia.
authors.forename: Alexey
authors.initials: A
authors.lastname: Martov
authors.affiliation: Department of Urology, Russian Medical Postgraduate Academy, Moscow City Hospital No. 57, Moscow, Russia.
authors.forename: Nikolay
authors.initials: N
authors.lastname: Baykov
authors.affiliation: Department of Urology, Medical University Salzburg, Salzburg, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Lusuardi
authors.affiliation: Department of Urology, Medical University Salzburg, Salzburg, Austria.
authors.forename: Günter
authors.initials: G
authors.lastname: Janetschek
authors.affiliation: Department of Urology, Humanitas Research Hospital, Milan, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Hurle
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Wolters
authors.affiliation: Institute of Pathology, Hannover Medical School, Hannover, Germany.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: von Klot
authors.affiliation: Department of Urology, Hospital of Wolfsburg, Wolfsburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Leitenberger
authors.affiliation: Department of Urology, Hospital of Wolfsburg, Wolfsburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Riedl
authors.affiliation: Department of Urology and Andrology, TILAK General Hospital Hall, Hall in Tyrol, Austria.
authors.forename: Udo
authors.initials: U
authors.lastname: Nagele
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.affiliation: Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Marko
authors.initials: M
authors.lastname: Babjuk
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. herrmann.thomas@mh-hannover.de.
authors.forename: Thomas R W
authors.initials: TR
authors.lastname: Herrmann
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D019459:Urothelium
keywords: Bladder cancer; En bloc; Holmium; Laser; TURBT; Thulium