The Comparision Of Green Laser Vaporization And Transurethral Resection Of Non Muscle-invasive Bladder Cancer

Objective:Bladder cancer is one of the most common malignant tumors in the Urology Department of China, of which most patients are diagnosed as with non muscle-invasive bladder cancer (NMIBC). Transurethral resection of bladder tumor (TURBT) is the main method for the treatment of the NMIBC. With the introduction and the development of laser technology, the treatment of the NMIBC has been provided with more choices. Bladder cancer postoperative bladder perfusion chemotherapy has become the standard treatment for the NMIBC, which significantly reduce the rate of the cancer recurrence. This study explores the treatment method of the green laser vaporization combined with Epirubicin immediate postoperative instillation to cure the NMIBC, which proves to be a better therapy for the NMIBC.Method:A group of56NMIBC patients treated with the green laser vaporization from Oct.2009to Jan.2012was compared with the control group of62NMIBC patients treated with the TURBT from Jan.2007to Oct.2009. The two groups of patients were all detected with B ultrasound, intravenous urography, CT and cystoscopy biopsy before operation for definite diagnosis of the NMIBC. With lumbar anesthesia, the operation processes of all the cases were in the television monitoring system. In the operations of the laser group, green laser system produced by American Laserscope company with a power of60～80W, the side optical fiber and STORZ green laser vaporization cystoscope and normal saline were used. In the operations of the TURBT group, Italy Excell High frequency electrosurgical generator with a power of120/70W, STORZ resectoscope and5%mannitol were used. During the operations, the index of the bleeding volume, the operation time, the obturator nerve reflex, the bladder perforation and the postoperative indwelling catheter time of the two groups were observed. After the operations, all the cases were treated with the intravesical instillation of chemotherapy within24hours, with50mg epirubicin dissolved in50ml normal saline and injected into the bladder through urethral catheter and discharged after holding for one hour. Afterwards we carried out routine perfusion of bladder once a week for8consecutive weeks to all the patients and then the bladder maintaining perfusion chemotherapy, once a month, for12continuous months. Postoperative regular B ultrasound and cystoscopy were followed up to detect the tumor recurrence.Results:There was no significant difference between the two groups in operation time (P>0.05). The bleeding volume, the indwelling catheter time, the postoperative hospital stay and the recurrence rate of the laser group was significantly lower than those of the TURBT group, with statistical significance (P<0.01). The laser group and the TURBT group showed significant difference considering postoperative bladder irrigation which was unnecessary in the former, while8cases in the latter. There was no obturator nerve reflex and bladder perforation in the laser group, while9cases and2cases respectively in the TURBT group. The postoperative intravesical instillation of epirubicin chemotherapy within24hours was well tolerated in the laser group, with only3cases showing irritation symptoms, while6cases in the TURBT group which showed significant difference between the two groups. All patients were followed up for one year, with5cases of recurrence and no in-field recurrence in the laser group, while9cases of recurrence in the TURBT group, of which3cases were in-field recurrence, showing a significant statistical difference.Conclusion:The green laser vaporization shows advantages as minimally invasive, less bleeding, rapid recovery, fewer complications and lower recurrence rate in curing the NMIBC, which is especially suitable for treating the lateral wall bladder tumor and for the elderly patients. The immediate postoperative intravesical instillation of epirubicin shows no significant irritation symptoms and does not delay the heal of the wound. The green laser vaporization combined with the immediate postoperative intravesical instillation of epirubicin proves to be an easy, safe and effective method for the treatment of the NMIBC.