Initial North American experience with the use of the Olympus Button Electrode for vaporization of bladder tumors

Department of Urology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
The Canadian Journal of Urology (Impact Factor: 0.98). 04/2012; 19(2):6211-6.
Source: PubMed


The current treatment standard of care for patients who present de novo or with a recurrent bladder tumor is transurethral resection of the bladder tumor (TURBT) using monopolar or bipolar electrocautery in the form of a 90-degree loop electrode, which has been used since its introduction in 1952. This intervention, accomplished transurethrally, is both diagnostic and potentially therapeutic for patients with bladder cancer, especially for low grade, non muscle-invasive bladder tumors. Although usually safe and sufficient, this technique can create technical challenges, especially in the dynamically changing spherical space of the bladder. Bipolar energy has been available for many years and has been readily adopted for the endoscopic treatment of benign prostatic enlargement. A further refinement on bipolar energy has been the recent introduction of the Olympus Button Electrode (Olympus, Southborough, MA, USA). Coupling bipolar energy into the Olympus Button Electrode not only harnesses the benefits of less thermal spread but also obviates many of the geometric challenges associated with loop electrodes during resection of either large or inauspiciously placed bladder tumors. In this article, we detail our initial experience vaporizing bladder tumors with the Olympus Button Electrode. Although still very early in our experience, we have been able to completely vaporize very large tumors as well as tumors located in difficult parts of the bladder to access with minimal blood loss and no bladder perforations. Furthermore, our ability to obtain adequate grade and stage information has not been compromised by using this vaporization technique.

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Available from: Viraj A Master, Mar 27, 2014
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    ABSTRACT: Purpose: Transurethral resection of bladder tumor (TURBT) is one of the most commonly performed procedures by practicing urologists for the diagnosis, staging, and treatment of non-muscle invasive bladder cancer (NMIBC). There is wide variation in the technique and quality of TURBT amongst urologists. This is the first and critically important diagnostic and staging tool in the management of bladder cancer which is a potentially lethal malignancy and the most costly urologic malignancy to manage. The aim of this review is to provide evidenced based rationale for the incorporation of novel technologies for TURBT in the setting of previously set standards. Materials and Methods: A systematic MEDLINE®/PubMed®, Cochrane Library, and Ovid MEDLINE® search was performed utilizing two separate search queries. The MEDLINE®/PubMed® search was performed using the keywords “transurethral resection bladder tumor” filtering the search to include studies published within the past 5 years, English language, and human species. A second search without filters was performed with the same keywords in the Cochrane Library and Ovid MEDLINE®. Study eligibility was defined based on patients with NMIBC, treatment with TURBT, and with variable comparators based on novel technology utilized. All study designs were accepted except case reports, animal studies, editorials, and review articles with various outcome measures reported including tumor detection, residual tumor detection, disease recurrence/progression, and adverse events. Results: The literature search ultimately yielded 971 manuscripts for review with 42 meeting inclusion criteria for systematic review. Refinements in technique and surgeon experience are critical for the performance of a thorough, complete, high-quality TURBT. Recent technological advances including bipolar electrocautery and regional anesthetic techniques may help reduce the complications associated with TURBT. Photodynamic diagnosis may help increase the diagnostic accuracy, reduce the recurrence rate, and decrease the cost in managing patients with NMIBC. Repeat TURBT and perioperative intravesical chemotherapy remain standard components in select patients with NMIBC. Appropriate clinical staging and treatment of patients with NMIBC remains a challenge. Conclusions: Recent advances in TURBT should aid its diagnostic accuracy, reduce recurrences, decrease complications, and reduce the cost of management of NMIBC. Urologists should incorporate these evidence-based strategies into current guideline recommendations to improve patient outcomes following TURBT in their everyday practice.
    No preview · Article · Jun 2014 · The Journal of urology
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    ABSTRACT: A prospective study was performed aiming to evaluate the surgical efficacy, perioperative safety profile, diagnostic accuracy and medium term results of a multi-modal approach consisting in narrow band imaging (NBI) cystoscopy and bipolar plasma vaporization (BPV) when compared to the standard protocol represented by white light cystoscopy (WLC) and transurethral resection of bladder tumors (TURBT). A total of 260 patients with apparently at least one bladder tumor over 3 cm were included in the trial. In the first group, 130 patients underwent conventional and NBI cystoscopy followed by BPV, while in a similar number of cases of the second arm, classical WLC and TURBT were applied. In all non-muscle invasive bladder tumors' (NMIBT) pathologically confirmed cases, standard monopolar Re-TUR was performed at 4-6 weeks after the initial intervention, followed by one year' BCG immunotherapy. The follow-up protocol included abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years. The obturator nerve stimulation, bladder wall perforation, mean hemoglobin level drop, postoperative bleeding, catheterization period and hospital stay were significantly reduced for the plasma vaporization technique by comparison to conventional resection. Concerning tumoral detection, the present data confirmed the NBI superiority when compared to standard WLC regardless of tumor stage (95.3% vs. 65.1% for CIS, 93.3% vs. 82.2% for pTa, 97.4% vs. 94% for pT1, 95% vs. 84.2% overall). During standard Re-TUR the overall (6.3% versus 17.4%) and primary site (3.6% versus 12.8%) residual tumors' rates were significantly lower for the NBI-BPV group. The 1 (7.2% versus 18.3%) and 2 (11.5% versus 25.8%) years' recurrence rates were substantially lower for the combined approach. NBI cystoscopy significantly improved diagnostic accuracy, while bipolar technology showed a higher surgical efficiency, lower morbidity and faster postoperative recovery. The combined technique offered a reduced rate of residual tumors at Re-TUR, both globally as well as for orthotopic tumors. Substantially lower recurrence rates were found at 1 and 2 years among the NBI-BPV cases.
    Full-text · Article · Jun 2014 · Journal of medicine and life
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    ABSTRACT: For patients with non-muscle invasive bladder cancer, cystoscopy and transurethral resection/vaporization of the bladder tumor plays an integral role in the treatment of a given patient's bladder cancer. Although considered the current gold standard for tumor detection, traditional or white light cystoscopy has been shown to have its limitations visualizing both small papillary tumors and/or carcinoma in-situ. Current efforts have been directed to closing this gap with data demonstrating that by identifying these previously missed lesions, tumor recurrence and progression rates are reduced, thereby improving patient outcomes. Narrow Band Imaging, which can be used during cystoscopy and transurethral resection/vaporization of bladder tumors, can aid in visualizing mucosal and sub-mucosal hypervascularity--a probable surrogate for malignant lesions--potentially visualizing the boundaries of lesions that may have been missed during white light cystoscopy alone. This technique may produce equivalent visual markers with fewer logistical hurdles than currently available methods. In this article, we detail our technique for the adjunctive use of Narrow Band Imaging during cystoscopy and transurethral resection/vaporization of bladder tumors to aid in visualizing mucosal and sub-mucosal hypervascularity. Although not yet readily adopted, Narrow Band Imaging may be a practical and easy to use adjunct to existing methods in visualizing occult bladder lesions.
    No preview · Article · Apr 2015 · The Canadian Journal of Urology