Comparison Of Endoscopic Therapies For Non-muscle Invasive Bladder Cancer:Transurethral En Bloc Resection Versus Traditional Transurethral Resection Of Bladder Tumor

Objective To explore the clinical effect and safety of three methods(plasma needle electrode,bladder tumor-endoscopic submucosal dissection(BT-ESD)and Holmium laser)en bloc resection for non-muscle invasive bladder cancer.Provide a more standardized treatment plan for patients with bladder cancer.Methods The clinical data of 137 patients with bladder tumor diagnosed in our center from July 2016 to March 2018 were retrospectively analyzed,including 31 patients in the BT-ESD group,35 patients in the needle electrode group,31 patients in the holmium laser group,and 40 patients in the TURBT group.Four groups of patients were observed for the presence or absence of bladder perforation,obturator nerve reflex,statistical single tumor resection time,total tumor resection time,postoperative bladder irrigation time,postoperative indwelling catheterization time,postoperative hospital stay.Kaplan-Meire survival analysis was performed for postoperative follow-up recurrence.Results There were no statistically differences in age,tumor location,number and tumor size in 137 patients.There was no uncontrollable bleeding and bladder perforation during operation.The en bloc resection group were compared with the TURBT,the obturator nerve reflex was lower(p<0.05),however in the operation time,the TURBT group was shorter than the en bloc resection group(p<0.05).And the postoperative indwelling catheterization time and hospital stay were more shorter in en bloc resection group.After 18 months of follow-up,3 patients(3/31 9.7%)relapsed in the BT-ESD group,3 patients(3/35 8.6%)relapsed in the needle electrode group,and 4 patients(4/31 12.9%)relapsed in the holmium laser group.There were 5 cases of recurrence in the TURBT group(5/40 12.5%),and there was no significant difference in recurrence(p=0.93).Conclusion The en bloc resection of bladder tumors has been accepted by more and more clinicians.The operation time is relatively longer than that of TURBT.However,the obturator nerve reflex probability is low,which reduces the serious complications during operation.The possibility of postoperative indwelling catheterization and short postoperative hospital stay can further reduce the economic burden of the patient,and it is an economical,effective and safe minimally invasive surgical procedure for bladder tumor patients.