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.
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.
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.
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.
World journal of urology. 2024 Feb 14*** epublish ***
Gernot Ortner, Selcuk Güven, Bhaskar Kumar Somani, Andre Nicklas, Jeremy Yuen-Chun Teoh, Ioannis Kartalas Goumas, Thorsten Bach, Fernando Gómez Sancha, Felipe C A Figueredo, Mario W Kramer, Giorgio Bozzini, Øyvind Ulvik, Panagiotis Kallidonis, Jean Baptiste Roche, Arkadiusz Miernik, Dmitry Enikeev, Chandra Mohan Vaddi, Naeem Bhojani, Petros Sountoulides, Lukas Lusuardi, Joyce Baard, Vineet Gauhar, Ali Ahmed, Christopher Netsch, Ali Serdar Gözen, Udo Nagele, Thomas R W Herrmann, Theodoros Tokas
Department of Urology and Andrology, General Hospital Hall I.T, Milser Straße 10, 6060, Hall in Tirol, Austria. ., Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Department of Urology and Andrology, General Hospital Hall I.T, Milser Straße 10, 6060, Hall in Tirol, Austria., S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., Department of Urology, Asklepios Westklinikum Rissen, Hamburg, Germany., Department of Urology, ICUA-Clínica CEMTRO, Madrid, Spain., Instituto da Próstata Aumentada, Hospital Pompéia, Caxias do Sul, Brazil., Department of Urology, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany., Department of Urology, ASST Lariana, Como, Italy., Department of Urology, Haukeland University Hospital, Bergen, Norway., Department of Urology, University of Patras, Patras, Greece., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Preeti Urology & Kidney Hospital, Hyderabad, India., Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada., 1st Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece., Departement of Urology, Paracelsus Medical University, Salzburg, Austria., Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, Frimley Health, NHS Foundation Trust, Frimley, UK., Department of Urology, Asklepios Klinik Barmbek, Hamburg, Germany., Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany., Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria.