Some RCTs were published showing controversial results. This may be due to the heterogeneity study design, using two different types of energy (laser ERBT versus electric TURBT) and different endpoints assessed. As reported in a recent International Collaborative Consensus,1 the current quality of evidence does not allow to draw solid conclusions.
In our study, we aim to provide the highest level of evidence for the comparison of ERBT versus TURBT to address the concerns about this topic.2 This is single center prospective randomized trial (NCT04712201) that enrolled 300 patients between April 2018 to June 2021. The patients were randomized with a 2:3 ratio to TURBT (n=60 monopolar, n=60 bipolar) and ERBT (n=60 monopolar, n=60 bipolar, n=60 Thulium:YAG laser). The primary endpoint was defined as the detrusor muscle presence rate in the specimen. The surgical, pathological, and oncological outcomes were analyzed for these two techniques.
We found that ERBT was non-inferior in detrusor muscle sampling (TURBT 94% vs ERBT 95%; p=0.8). No difference was found in complication rate (p=0.5), rates of postoperative adjuvant treatment (p=0.1), catheterization time (p=0.2) and hospital stay (p=0.6).
T1 sub-staging feasibility rate was significantly higher in the ERBT group than in TURBT (100% vs 80%; p=0.02). Regarding oncological outcomes, both disease persistence at 3 months and recurrence-free survival at median follow-up of 12 months were comparable between the groups (p=0.16)
A recent sub-analysis of this population showed no difference in staging feasibility among energies (monopolar, bipolar, and laser) in ERBT (p=0.796).3 Laser energy might be beneficial in lateral wall lesions to avoid obturator nerve reflex (p<0.05). An increased risk of ERBT conversion to conventional TURBT was found for lesions located in the anterior wall.
Our findings show that TURBT and ERBT have comparable outcomes even when using a different type of energy. The heterogeneity of operators, both senior urologists (>5 years of experience), junior urologists (<5 years of experience), and urology residents could help to translate these findings into a real-life scenario where ERBT and TURBT could be performed in any center.
Written by: Andrea Gallioli,1 Pietro Diana,1 Matteo Fontana,1 Angelo Territo,1 Óscar Rodriguez-Faba,1 Josep Maria Gaya,1 Francesco Sanguedolce,1 Jordi Huguet,1 Asier Mercade,1 Alberto Piana,1 Julia Aumatell,1 Alejandra Bravo-Balado,1 Ferran Algaba,2 Joan Palou,1 Alberto Breda1
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain
- Fundació Puigvert, Department of Pathology, Autonomous University of Barcelona, Barcelona, Spain
- Teoh JY, MacLennan S, Chan VW, et al. An International Collaborative Consensus Statement on En Bloc Resection of Bladder Tumour Incorporating Two Systematic Reviews, a Two-round Delphi Survey, and a Consensus Meeting. Eur Urol. 2020 Oct;78(4):546-569. doi: 10.1016/j.eururo.2020.04.059. Epub 2020 May 8. PMID: 32389447.
- Gallioli A, Diana P, Fontana M, et al. En Bloc Versus Conventional Transurethral Resection of Bladder Tumors: A Single-center Prospective Randomized Noninferiority Trial. Eur Urol Oncol. 2022 May 23:S2588-9311(22)00068-2. doi: 10.1016/j.euo.2022.05.001. Epub ahead of print. PMID: 35618567.
- P Diana, A Gallioli, M Fontana, et al.. Energy source comparison in en-bloc resection of bladder tumors: subanalysis of a single-center prospective randomized study. World Journal of Urology. Under publication
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