Holmium Laser and Transurethral Electroresection for Superficial Bladder Cancer: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WU Gang ,  GU BaoJun

Department of Urology, Sixth People’s Hospital, Jiaotong University of Shanghai, Shanghai 200233, China;

Corresponding author：

GU BaoJun, Email: baojun70@sohu.com

Keywords：

Bladder cancer; Holmium laser; Electroresection; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20110098

Video：

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Objective 　To assess the safety and efficacy of holmium laser resection for superficial bladder cancer (HoLRBT) compared with electrocautery transurethral resection of bladder tumor (TURBT).
Methods 　Such databases as MEDLINE, EMbase, CBM, and The Cochrane Library were searched by computer to include the randomized controlled trials (RCTs) about holmium laser and transurethral electroresection for treating superficial bladder cancer. Meta-analyses were performed by RevMan 5.0 software after the data were abstracted and the quality was evaluated. Results 　Nine RCTs involving 1 323 patients were included. The results of meta-analyses showed in comparison with the TURBT, there were significant differences in HoLRBT for less intraoprative bleeding volume (WMD= –6.04, 95%CI –6.90 to –5.19), shorter mean bladder irrigating time (WMD= –14.99, 95%CI –17.58 to –12.40), shorter time of indwelling urethral catheter (WMD= –2.46, 95%CI –3.59 to –1.34), fewer postoperative complications such as the obturator nerve reflex (OR=0.03, 95%CI 0.01 to 0.09), fewer events of bladder perforation (OR=0.12, 95%CI 0.05 to 0.31) and lower postoperative recurrence rate (OR=0.70, 95%CI 0.52 to 0.96).
Conclusions 　The current evidence shows that HoLRBT is a feasible, safe, and effective alternative for the management of superficial bladder cancer because of few damages to bladder tissues and less operation bleeding.

Citation： WU Gang,GU BaoJun. Holmium Laser and Transurethral Electroresection for Superficial Bladder Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(5): 554-559. doi: 10.7507/1672-2531.20110098 Copy

1.	3 Parsons RL, Campbel JL, Thomley MW, et al . The effect of the laser of dog bladders: a preliminary report. J Urol , 1966, 95(5): 716-717.
2.	4 Fried NM. Therapeutic applications of lasers in urology: An update. Expert Rev Med Devices , 2006, 3(1): 81-94.
3.	5 Soler-Martínez J, Vozmediano-Chicharro R, Morales-Jiménez P. Holmium laser treatment for low grade, low stage, noninvasive bladder cancer with local anesthesia and early instillation of mitomycin C. J Urol , 2007, 178(6): 2337-2339.
4.	15 Syed HA, Biyani CS, Bryan N, et al . Holmium: YAG laser treatment of recurrent superficial bladder carcinoma: Initial clinical experience. J Endourol , 2001, 15(6): 625-527.
5.	16 Hossain MZ, Khan SA, Salam MA, et al . Holmium: YAG laser treatment of superficial bladder carcinoma. Mymensingh Med J , 2005, 14(1): 13-15.
6.	18 Muraro GB, Grifoni R, Spazzafumo L. Endoscopic therapy of superficial bladder cancer in high-risk patients: Holmium laser versus transurethral resection. Surg Technol Int , 2005, 14: 222-226.
7.	19 Marks AJ, Teichman JM. Lasers in clinical urology: State of the art and new horizons. World J Urol , 2007, 25(3): 227-233.
8.	21 Oliva Encina J, Marco Valdenebro A, Pelegrí Gabarró J, et al . Beyond the photodynamic diagnosis: Searching for excellence in the diagnosis of non-muscle-invasive bladder cancer. Actas Urol Esp , 2010, 34(8): 657-668.
9.	22 Takahashi T, Kakehi Y, Mitsumori K, et al . Distinct microsatellite alterations in upper urinary tract tumors and subsequent bladder tumors. J Urol , 2001, 165(2): 672-677.
10.	23 Syed HA, Biyani CS, Bryann, et al . Holmium: YAG Laser treatment of recurrent superficial bladder carcinoma: initial clinical experience. J Endonrol , 2001, 15(6): 625-627.
11.	24 Millan-Rodriquez F, Chechile-Tomoiolo G, Salvador-Bayarri J, et al. Multivariate analysis of the prognostic facters of primary superficial bladder cancer. J Urol , 2002, 163(1): 73-78.
12.	25 Zhu Y, Jiang X, Zhang J, et al . Safety and efficacy of holmium laser resection for primary nonmuscle-invasive bladder cancer versus transurethral electroresection: single-center experience. Urology , 2008, 72(3): 608-612.
13.	董胜国, 周荣祥, 主编. 膀胱肿瘤. 北京: 人民卫生出版社, 2007: 1-5.
14.	吴阶平. 吴阶平泌尿外科学. 济南: 山东科学技术出版社, 2003, 11965-11973.
15.	朱耀丰, 陈军, 姜先洲, 等. HOLRBT治疗膀胱肿瘤疗效观察. 山东医药, 2010, 50(6): 104-107.
16.	葛永超, 王志余, 张力, 等. 钬激光治疗膀胱癌. 医药论坛杂志, 2008, 29(7): 10-12.
17.	张庆德, 宋希双. 钬激光治疗浅表性膀胱癌的疗效与随访, 大连: 大连医科大学, 2009.
18.	向松涛, 王树声, 甘澍, 等. 经尿道电切术与钬激光消融术治疗浅表膀胱肿瘤疗效比较, 临床泌尿外科杂志, 2009, 24(11): 851-853.
19.	刘玉强, 王传运, 徐祗顺, 等. 经尿道钬激光膀胱肿瘤切除临床指标对比分析, 中国内镜杂志, 2005, 11(12): 1233-1240.
20.	黄健, 亓林. 经尿道钬激光汽化与经尿道电切治疗表浅膀胱肿瘤临床比较. 安徽医科大学学报, 2008, 43(5): 83-85.
21.	沈肖曹, 杜传军, 史时芳, 等. 经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效比较. 中华泌尿外科杂志, 2005, 26(1): 30-32.
22.	沈瑞存, 邵可可, 李兵, 等. 经尿道钬激光切除与经尿道汽化电切治疗膀胱肿瘤的临床疗效分析, 临床杂志, 2008, 17（16）: 80-82.
23.	罗勇, 曹志刚, 刘军, 等. 经尿道钬激光与电切治疗表浅性膀胱肿瘤的临床疗效比较.肿瘤, 2008, 28(11): 1001-1003.
24.	夏术阶, 孙晓文, 朱江, 等. 经尿道钬激光局部膀胱壁切除治疗肌层浸润性膀胱肿瘤. 中华泌尿外科杂志, 2005, 26: 352.
25.	陈伟, 薄隽杰, 张连华, 等. 经尿道HO: YAG 激光治疗浅表性膀胱肿瘤的临床分析(附92例报告). 临床泌尿外科杂志, 2009, 24(3): 206-208.

1. 3 Parsons RL, Campbel JL, Thomley MW, et al . The effect of the laser of dog bladders: a preliminary report. J Urol , 1966, 95(5): 716-717.
2. 4 Fried NM. Therapeutic applications of lasers in urology: An update. Expert Rev Med Devices , 2006, 3(1): 81-94.
3. 5 Soler-Martínez J, Vozmediano-Chicharro R, Morales-Jiménez P. Holmium laser treatment for low grade, low stage, noninvasive bladder cancer with local anesthesia and early instillation of mitomycin C. J Urol , 2007, 178(6): 2337-2339.
4. 15 Syed HA, Biyani CS, Bryan N, et al . Holmium: YAG laser treatment of recurrent superficial bladder carcinoma: Initial clinical experience. J Endourol , 2001, 15(6): 625-527.
5. 16 Hossain MZ, Khan SA, Salam MA, et al . Holmium: YAG laser treatment of superficial bladder carcinoma. Mymensingh Med J , 2005, 14(1): 13-15.
6. 18 Muraro GB, Grifoni R, Spazzafumo L. Endoscopic therapy of superficial bladder cancer in high-risk patients: Holmium laser versus transurethral resection. Surg Technol Int , 2005, 14: 222-226.
7. 19 Marks AJ, Teichman JM. Lasers in clinical urology: State of the art and new horizons. World J Urol , 2007, 25(3): 227-233.
8. 21 Oliva Encina J, Marco Valdenebro A, Pelegrí Gabarró J, et al . Beyond the photodynamic diagnosis: Searching for excellence in the diagnosis of non-muscle-invasive bladder cancer. Actas Urol Esp , 2010, 34(8): 657-668.
9. 22 Takahashi T, Kakehi Y, Mitsumori K, et al . Distinct microsatellite alterations in upper urinary tract tumors and subsequent bladder tumors. J Urol , 2001, 165(2): 672-677.
10. 23 Syed HA, Biyani CS, Bryann, et al . Holmium: YAG Laser treatment of recurrent superficial bladder carcinoma: initial clinical experience. J Endonrol , 2001, 15(6): 625-627.
11. 24 Millan-Rodriquez F, Chechile-Tomoiolo G, Salvador-Bayarri J, et al. Multivariate analysis of the prognostic facters of primary superficial bladder cancer. J Urol , 2002, 163(1): 73-78.
12. 25 Zhu Y, Jiang X, Zhang J, et al . Safety and efficacy of holmium laser resection for primary nonmuscle-invasive bladder cancer versus transurethral electroresection: single-center experience. Urology , 2008, 72(3): 608-612.
13. 董胜国, 周荣祥, 主编. 膀胱肿瘤. 北京: 人民卫生出版社, 2007: 1-5.
14. 吴阶平. 吴阶平泌尿外科学. 济南: 山东科学技术出版社, 2003, 11965-11973.
15. 朱耀丰, 陈军, 姜先洲, 等. HOLRBT治疗膀胱肿瘤疗效观察. 山东医药, 2010, 50(6): 104-107.
16. 葛永超, 王志余, 张力, 等. 钬激光治疗膀胱癌. 医药论坛杂志, 2008, 29(7): 10-12.
17. 张庆德, 宋希双. 钬激光治疗浅表性膀胱癌的疗效与随访, 大连: 大连医科大学, 2009.
18. 向松涛, 王树声, 甘澍, 等. 经尿道电切术与钬激光消融术治疗浅表膀胱肿瘤疗效比较, 临床泌尿外科杂志, 2009, 24(11): 851-853.
19. 刘玉强, 王传运, 徐祗顺, 等. 经尿道钬激光膀胱肿瘤切除临床指标对比分析, 中国内镜杂志, 2005, 11(12): 1233-1240.
20. 黄健, 亓林. 经尿道钬激光汽化与经尿道电切治疗表浅膀胱肿瘤临床比较. 安徽医科大学学报, 2008, 43(5): 83-85.
21. 沈肖曹, 杜传军, 史时芳, 等. 经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效比较. 中华泌尿外科杂志, 2005, 26(1): 30-32.
22. 沈瑞存, 邵可可, 李兵, 等. 经尿道钬激光切除与经尿道汽化电切治疗膀胱肿瘤的临床疗效分析, 临床杂志, 2008, 17（16）: 80-82.
23. 罗勇, 曹志刚, 刘军, 等. 经尿道钬激光与电切治疗表浅性膀胱肿瘤的临床疗效比较.肿瘤, 2008, 28(11): 1001-1003.
24. 夏术阶, 孙晓文, 朱江, 等. 经尿道钬激光局部膀胱壁切除治疗肌层浸润性膀胱肿瘤. 中华泌尿外科杂志, 2005, 26: 352.
25. 陈伟, 薄隽杰, 张连华, 等. 经尿道HO: YAG 激光治疗浅表性膀胱肿瘤的临床分析(附92例报告). 临床泌尿外科杂志, 2009, 24(3): 206-208.

Chinese Journal of Evidence-Based Medicine

Holmium Laser and Transurethral Electroresection for Superficial Bladder Cancer: A Meta-analysis

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