Top

World Journal of Urology

Published in:

01-08-2011 | Original Article

Waterjet hydrodissection: first experiences and short-term outcomes of a novel approach to bladder tumor resection

Authors: U. Nagele, M. Kugler, A. Nicklas, A. S. Merseburger, U. Walcher, G. Mikuz, T. R. Herrmann

Published in: World Journal of Urology | Issue 4/2011

Abstract

Introduction

TURB is the standard approach to bladder tumors but suffers from several disadvantages. Waterjet hydrodissection is a new technology for removing superficial tumors in the GI tract promising to preserve the histological structures of biopsy specimens with favorable long-term results as recent studies have shown. The aim of this study was to show the feasibility and applicability of waterjet hydrodissection for removing papillary superficial bladder tumors.

Materials and methods

In five patients diagnosed with superficial papillary bladder tumor, transurethral submucosal dissection was conducted using the T-type I-Jet HybridKnife (Erbe, Tuebingen). The resection edges were labeled by means of electrical coagulation with the HybridKnife. Subsequently, a submucosal fluid cushion specific to the tissue layer was formed by the waterjet implementation function of the HybridKnife, thereby elevating the tumorous tissue. The tumor was endoscopically extracted with a retrieval bag. Biopsy specimens of the tumor edges and base were subsequently collected.

Results

All tumors could be resected en bloc, and the lamina propria was intact in all specimens, allowing the pathologist to distinguish between superficial and invasive tumors. Pathological analysis confirmed R0 resection in all samples.

Conclusion

These initial results prove the feasibility of waterjet hydrodissection for removing bladder tumors. In contrast to conventional TURB, this new technique allows the pathologist to assess the entire lamina propria and the resection edges due to the en-bloc resection and to determine invasiveness as well as R0 versus R1 resection. These first results are promising, long-term oncological follow-up, and prospective randomized surveys investigating the recurrence rate have to be evaluated.

Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J (2008) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol 54(2):303–314PubMedCrossRef

Bach T, Herrmann TR, Cellarius C, Geavlete B, Gross AJ, Jecu M (2009) Bipolar resection of the bladder and prostate–initial experience with a newly developed regular sized loop resectoscope. J Med Life 2(4):443–446PubMed

Slaton JW, Swanson DA, Grossman HB, Dinney CP (1999) A stage specific approach to tumor surveillance after radical cystectomy for transitional cell carcinoma of the bladder. J Urol 162(3 Pt 1):710–714PubMedCrossRef

Erckert M, Stenzl A, Falk M, Bartsch G (1996) Incidence of urethral tumor involvement in 910 men with bladder cancer. World J Urol 14(1):3–8PubMedCrossRef

Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39(5):418–422PubMedCrossRef

Niimi K, Fujishiro M, Kodashima S, Goto O, Ono S, Hirano K, Minatsuki C, Yamamichi N, Koike K (2010) Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 42(9):723–729PubMedCrossRef

Sylvester RJ, Oosterlinck W, van der Meijden AP (2004) A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol 171(6 Pt 1):2186–2190PubMedCrossRef

Eble JN, Sauter G, Epstein JI et al (2004) World health organization classification of tumours: pathology and genetics of tumours of the urinary system and male genital organs. IARC Press, Lyon

Wilby D, Thomas K, Ray E, Chapell E, O′Brien T (2009) Bladder cancer: new TUR techniques. World J Urol 27(3):309–312PubMedCrossRef

10.

Saito S (2001) Transurethral en bloc resection of bladder tumors. J Urol 166(6):2148–2150PubMedCrossRef

11.

Xishuang S, Deyong Y, Xiangyu C (2010) Comparing the safety and efficiency of conventional monopolar, plasmakinetic, and holmium laser transurethral resection of primary non-muscle invasive bladder cancer. J Endourol 24(1):69–73PubMedCrossRef

12.

Kawada T, Ebihara K, Suzuki T, Imai K, Yamanaka H (1997) A new technique for transurethral resection of bladder tumors: rotational tumor resection using a new arched electrode. J Urol 157:2225–2226PubMedCrossRef

13.

Ukai R, Kawashita E, Ikeda H (2000) A new technique for transurethral resection of superficial bladder tumor in 1 piece. J Urol 163:878PubMedCrossRef

14.

Zhu Y, Jiang X, Zhang J, Chen W, Shi B, Xu Z (2008) Safety and efficacy of holmium laser resection for primary nonmuscle-invasive bladder cancer versus transurethral electroresection: single-center experience. Urology 72(3):608–612PubMedCrossRef

Title: Waterjet hydrodissection: first experiences and short-term outcomes of a novel approach to bladder tumor resection
Authors: U. Nagele
M. Kugler
A. Nicklas
A. S. Merseburger
U. Walcher
G. Mikuz
T. R. Herrmann
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 4/2011
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-011-0653-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Waterjet hydrodissection: first experiences and short-term outcomes of a novel approach to bladder tumor resection

Abstract

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2011

Effect of parathyroid hormone on hypogonadism induced bone loss of proximal femur of orchiectomized rat

Erratum to: No need for systemic heparinization during laparoscopic donor nephrectomy with short warm ischemia time

External validation and applicability of the EORTC risk tables for non-muscle-invasive bladder cancer

Does the greater number of lymph nodes removed during standard lymph node dissection predict better patient survival following radical cystectomy?

Impact of gender on bladder cancer incidence, staging, and prognosis

Long-term experience with early single Mitomycin C instillations in patients with low-risk non-muscle-invasive bladder cancer: prospective, single-centre randomised trial