Thulium laser en bloc resection is a safe and efficacious alternative to conventional bipolar transurethral resection of bladder tumors.

Introduction: Bipolar transurethral resection of bladder tumors (bTURBT) is the standard of care technique for the management of bladder tumors; however, new techniques such as thulium laser en bloc resection of bladder tumors (TmLRBT) have been introduced as alternatives to bTURBT. In this study, detrusor muscle acquisition, perioperative outcomes and survival outcomes after TmLRBT and bTURBT were prospectively compared in patients with primary bladder tumors (1-5 cm). Material and methods: This prospective interventional study, conducted over ten years, involved 542 patients under a single surgeon. Inclusion criteria were a single tumor of 1-5 cm. The primary endpoint was the presence or absence of detrusor muscle. Perioperative criteria included operative time, hospital stay length, catheterization duration, bladder perforations, readmissions, and complication incidence. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method with subgroup comparisons by the log-rank test. Results: Of 449 patients, 211 underwent TmLRBT and 238 underwent bTURBT. Detrusor muscle was present in 201 (95.2%) TmLRBT patients vs 154 (64.7%) bTURBT patients (p <0.001). Complications were less frequent in the TmLRBT group (p <0.05). Hemoglobin drop (p <0.001), hospital stay (p <0.001), catheterization duration (p <0.001), and operative time (p <0.001) were all significantly lower in the TmLRBT group. Kaplan-Meier analysis showed no significant differences in RFS (p = 0.255) and CSS (p = 0.258) between the groups. Conclusions: TmLRBT demonstrated significantly better detrusor muscle inclusion and perioperative outcomes compared to bTURBT.