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Experts’ recommendations in laser use for the treatment of bladder cancer: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training and Research in Urological Surgery and Technology (TRUST)-Group

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Abstract

Purpose

To identify laser settings and limits applied by experts during laser vaporization (vapBT) and laser en-bloc resection of bladder tumors (ERBT) and to identify preventive measures to reduce complications.

Methods

After a focused literature search to identify relevant questions, we conducted a survey (57 questions) which was sent to laser experts. The expert selection was based on clinical experience and scientific contribution. Participants were asked for used laser types, typical laser settings during specific scenarios, and preventive measures applied during surgery. Settings for a maximum of 2 different lasers for each scenario were possible. Responses and settings were compared among the reported laser types.

Results

Twenty-three of 29 (79.3%) invited experts completed the survey. Thulium fiber laser (TFL) is the most common laser (57%), followed by Holmium:Yttrium–Aluminium-Garnet (Ho:YAG) (48%), continuous wave (cw) Thulium:Yttrium–Aluminium-Garnet (Tm:YAG) (26%), and pulsed Tm:YAG (13%). Experts prefer ERBT (91.3%) to vapBT (8.7%); however, relevant limitations such as tumor size, number, and anatomical tumor location exist. Laser settings were generally comparable; however, we could find significant differences between the laser sources for lateral wall ERBT (p = 0.028) and standard ERBT (p = 0.033), with cwTm:YAG and pulsed Tm:YAG being operated in higher power modes when compared to TFL and Ho:YAG. Experts prefer long pulse modes for Ho:YAG and short pulse modes for TFL lasers.

Conclusion

TFL seems to have replaced Ho:YAG and Tm:YAG. Most laser settings do not differ significantly among laser sources. For experts, continuous flow irrigation is the most commonly applied measure to reduce complications.

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Data availability

Data of this study are available upon request.

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Funding

None.

Author information

Authors and Affiliations

  1. Department of Urology and Andrology, General Hospital Hall I.T, Milser Straße 10, 6060, Hall in Tirol, Austria

    Gernot Ortner, Andre Nicklas & Udo Nagele

  2. Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria

    Gernot Ortner, Andre Nicklas, Udo Nagele, Thomas R. W. Herrmann & Theodoros Tokas

  3. Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey

    Selcuk Güven

  4. Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Bhaskar Kumar Somani

  5. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Jeremy Yuen-Chun Teoh

  6. Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy

    Ioannis Kartalas Goumas

  7. Department of Urology, Asklepios Westklinikum Rissen, Hamburg, Germany

    Thorsten Bach

  8. Department of Urology, ICUA-Clínica CEMTRO, Madrid, Spain

    Fernando Gómez Sancha

  9. Instituto da Próstata Aumentada, Hospital Pompéia, Caxias do Sul, Brazil

    Felipe C. A. Figueredo

  10. Department of Urology, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany

    Mario W. Kramer

  11. Department of Urology, ASST Lariana, Como, Italy

    Giorgio Bozzini

  12. Department of Urology, Haukeland University Hospital, Bergen, Norway

    Øyvind Ulvik

  13. Department of Urology, University of Patras, Patras, Greece

    Panagiotis Kallidonis

  14. Department of Urology, Clinique Saint-Augustin, Bordeaux, France

    Jean Baptiste Roche

  15. Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany

    Arkadiusz Miernik

  16. Department of Urology, Medical University of Vienna, Vienna, Austria

    Dmitry Enikeev

  17. Karl Landstainer Institute of Urology and Andrology, Vienna, Austria

    Dmitry Enikeev

  18. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Dmitry Enikeev

  19. Department of Urology, Preeti Urology & Kidney Hospital, Hyderabad, India

    Chandra Mohan Vaddi

  20. Division of Urology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC, Canada

    Naeem Bhojani

  21. 1st Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Petros Sountoulides

  22. Departement of Urology, Paracelsus Medical University, Salzburg, Austria

    Lukas Lusuardi

  23. Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Joyce Baard

  24. Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore

    Vineet Gauhar

  25. Department of Urology, Frimley Health, NHS Foundation Trust, Frimley, UK

    Ali Ahmed

  26. Department of Urology, Asklepios Klinik Barmbek, Hamburg, Germany

    Christopher Netsch

  27. Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany

    Ali Serdar Gözen

  28. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  29. Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece

    Theodoros Tokas

Authors
  1. Gernot Ortner
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  2. Selcuk Güven
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  3. Bhaskar Kumar Somani
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  4. Andre Nicklas
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  5. Jeremy Yuen-Chun Teoh
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  6. Ioannis Kartalas Goumas
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  8. Fernando Gómez Sancha
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  9. Felipe C. A. Figueredo
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  13. Panagiotis Kallidonis
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  15. Arkadiusz Miernik
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  22. Vineet Gauhar
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  23. Ali Ahmed
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  28. Theodoros Tokas
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Contributions

GO and TT had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TT. Acquisition of data: GO, TT, SG, BKS, AN, JYCT, JKG, TB, FGS, FCAF, MWK, GB, OU, PK, JBR, AM, DE, CMV, NB, PS, LL, JB, VG, AA, CN, ASG, UN, TH. Analysis and interpretation: GO, TT. Drafting of the manuscript: GO, TT. Critical revision of the manuscript: TT, BKS, SG, TH, UN, ASG. Statistical analysis: GO. Obtaining funding: None. Administrative, technical, or material support: GO, TT, UN, TH. Supervision: TT.

Corresponding author

Correspondence to Gernot Ortner.

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Conflict of interest

Gernot Ortner certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Udo Nagele: Consultant Karl Storz, Baxter, Boston Scientific, Optimed, Storz medical, B + K. Naeem Bhojani: Consultant Boston Scientific, Olympus, Procept Biorobotics, Panagiotis Kallidonis: Consultant Cook Medical, EMS. Joyce Baard: Consultant Coloplast, Boston Scientific, Olympus, Urogen. Christopher Netsch: Consultant Richard Wolf. Øyvind Ulvik: Lectures Olympus. Jeremy Yuen-Chun Teoh: Honoraria and Grants Olympus.

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None.

Research involving human participants and/or animals

This study does not involve human participants and/or animals.

Informed consent

No patients were included in the study.

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Ortner, G., Güven, S., Somani, B.K. et al. Experts’ recommendations in laser use for the treatment of bladder cancer: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training and Research in Urological Surgery and Technology (TRUST)-Group. World J Urol 42, 79 (2024). https://doi.org/10.1007/s00345-024-04786-9

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