Comparative study of 2 um laser versus Holmium laser for the resection of non-muscle invasive bladder cancer

Objectives: To compare the safety and efficacy of conventional monopolar transurethral resection of bladder tumor (TURBT), 2-micron continuous-wave laser and holmium laser resection techniques in the management of primary non-muscle invasive bladder tumor (NMIBT). Methods: From January 2009 to January 2013, 210 patients newly diagnosed primary NMIBC were enrolled randomly in this study, including conventional TURBT group (n=70), holmium laser group (n=70) and 2-micron laser group (n=70). We retrospectively analyze and record operative time, postoperative bladder irrigation, catheterization time, hospitalization time, complications included obturator nerve reflex, bladder perforation, blood transfusion, and 2-year tumor recurrence rate in all patients. Results: Characteristics of patients and tumors in all three groups were compared before surgery. There was no significant difference in operative time among the three groups. Compared with the conventional TURBT group, both 2-micron and holmium groups had less intraoperative and postoperative complications, including obturator nerve reflex, bladder perforation, and postoperative bladder irritation. There were no significant differences among the three groups in the blood transfusion rate and incidence of urethral stricture. Patients in the 2-micron and holmium groups had less catheterization and hospitalization time than those in the conventional TURBT group. There was no significant difference in the 2-year tumor recurrence rate among the three groups. Conclusion: Our results demonstrated that the use of 2-micron (thulium) laser and holmium laser in the management of NMIBT were superior to conventional monopolar TURBT, while there were no significant differences between 2-micron laser and holmium laser. However, 2-micron laser and holmium laser did not have an obvious advantage over conventional TURBT in 2-year tumor recurrence rate. A longer follow-up period and larger numbers of patients are necessary to demonstrate the present result in the future.