Investig Clin Urol.  2018 Jul;59(4):223-231. 10.4111/icu.2018.59.4.223.

Can tumor recurrence be reduced with plasma-kinetic vaporization of the area around the tumor in nonmuscle invasive bladder cancer?

• Yılmaz Y
• Kahya MC
• Dilek FH
• Köse O
• Özcan S
• Can E
• Akın Y
• Ergani B
• Dindar AS

• KMID: 2414754
• DOI: http://doi.org/10.4111/icu.2018.59.4.223

Abstract

PURPOSE
To investigate the effect on recurrence of vaporization of the tumor surroundings and suspicious areas with a plasma-kinetic (PK) system after transurethral resection (TUR) of nonmuscle invasive bladder cancer.
MATERIALS AND METHODS
The study included 121 patients with a primary superficial bladder tumor who were randomized as those who underwent TUR with the PK system (Group 1, n=62) and those who underwent TUR with the monopolar system (Group 2, n=59). The vaporization procedure was performed by suppressing the cutting option of the PK system for a period, which would accumulate energy sufficient to make swelling-waves on the mucosa very close to the area of the loop to be vaporized.
RESULTS
A total of 121 patients who met the study criteria were included for evaluation. Recurrence was determined in 21 patients in Group 1 (33.87%) and in 29 patients in Group 2 (49.15%) (p=0.088). Recurrence was close to the old resection site in 6 of 21 patients in Group 1, and in 13 patients in Group 2 (p=0.028); the difference was statistically significant. No statistically significant difference was determined between the two groups with respect to age, gender, number of tumor foci, rate or range of additional treatments applied, cigarette smoking rate, repeat TUR rate and rate of tumor en- countered in repeat TUR, T-stage, and tumor grade.
CONCLUSIONS
The effect of vaporization on recurrence by the PK system may seem similar to the effect of standard TUR, the recurrence- lowering effect surrounding nonmuscle invasive bladder cancers is better.

Keyword

Recurrence; Surgery, cystoscopic; Urinary bladder neoplasms; Vaporization

MeSH Terms

Cystoscopy
Humans
Mucous Membrane
Recurrence*
Smoking
Urinary Bladder Neoplasms*
Urinary Bladder*
Volatilization*

Figure

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  Fig. 1 Nonmuscle invasive bladder cancer.

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  Fig. 2 Vaporization following resection, showing necrosis of the epithelium and muscle tissue (H&E, ×100).

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  Fig. 3 Histopathological image of a specimen taken from the same area following vaporization. Varying degrees of necrosis are observed: necrosis is generally more active in the mucosa, the epithelium has fallen away in all areas, and evident necrosis is seen in the muscle layer in some samples (H&E, ×100).

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  Fig. 4 Tumor resection and vaporization of the surrounding area (the vaporized area is seen in the form of a halo surrounding the resection area and paler than the mucosa).

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