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Der Urologe

, Volume 57, Issue 6, pp 665–672 | Cite as

En-bloc-Resektion und Vaporisation von Harnblasenkarzinomen

  • J. P. Struck
  • A. Karl
  • C. Schwentner
  • T. R. W. Herrmann
  • M. W. Kramer
Leitthema
  • 127 Downloads

Zusammenfassung

Hintergrund

Modifikationen in der endourologischen Therapie von Harnblasentumoren haben das Ziel, bekannte Schwächen der konventionellen transurethralen Resektionstechnik (z. B. Tumorfragmentierung) zu verbessern (En-bloc-Resektion, ERBT) oder den allgemeinen Behandlungsrhythmus zu vereinfachen (Vaporisation).

Ziel der Arbeit

Die vorliegende Übersichtsarbeit präsentiert die aktuelle Datenlage im Hinblick auf die verwendeten Techniken, die zu erwartende histopathologische Qualität der Präparate, die perioperativen Komplikationen und das onkologische Ergebnis.

Material und Methoden

Sowohl für die ERBT als auch für die Vaporisation erfolgten jeweils separate Datenrecherchen. Zum Thema ERBT wurden 27 und zum Thema Vaporisation 15 Artikel identifiziert.

Ergebnisse

Zumeist wird die ERBT durch eine zirkumferentielle Inzision in die Mukosa durchgeführt. Alternativ kann der Tumor von vorne unterminierend enukleiert werden. Die Resektionsqualität lässt sich anhand höherer Detrusornachweisraten (90–100 %) verbessern. Relevante Unterschiede zur konventionellen transurethralen Resektion der Harnblase (TURB) im Hinblick auf die perioperative Komplikationsrate wurden nicht nachgewiesen, allenfalls eine verringerte Rate einer N. obturatorius bedingten Blasenperforation bei der Laser-ERBT. Hinsichtlich der Rezidivraten zeigt sich ein statistisch nicht signifikanter Trend zugunsten der ERBT. Vaporisationen eignen sich für Patienten mit niedriger Risikokonstellation in der primären TURB. Sie können unter Anwendung von Lokalanästhetika ambulant und ohne Narkose durchgeführt werden.

Schlussfolgerung

Die ERBT zeigt vielversprechende Ergebnisse im Hinblick auf die Verbesserung der histopathologischen Auswertbarkeit. Die Umsetzung der Vaporisation als flächendeckend eingesetzte Methodik scheitert derzeit am deutschen Vergütungssystem.

Schlüsselwörter

Resektion, transurethrale Tumorextraktion Obturatoriusreflex TURB ERBT 

En bloc resection and vaporization techniques for the treatment of bladder cancer

Abstract

Background

Modifications in resection techniques may overcome obvious limitations of conventionally performed transurethral resection (e. g., tumor fragmentation) of bladder tumors or provide an easier patient treatment algorithm (e. g., tumor vaporization).

Objectives

The present review article summarizes the current literature in terms of en bloc resection techniques, histopathological quality, complication rates, and oncological outcomes.

Materials and methods

A separate data search was performed for en bloc resection (ERBT, n = 27) and vaporization (n = 15) of bladder tumors.

Results

In most cases, ERBT is performed in a circumferential fashion. Alternatively, ERBT may be performed by undermining the tumor base via antegrade application of short energy impulses. Based on high rates of detrusor in specimens of ERBT (90–100%), a better histopathological quality is assumed. Significant differences in perioperative complication rates have not been observed, although obturator-nerve-based bladder perforations are not seen when laser energy is used. There is a nonstatistically significant trend towards lower recurrence rates in ERBT groups. Tumor vaporization may provide a less invasive technique for older patients with recurrences of low-risk bladder cancer. It can be performed in an outpatient setting.

Conclusions

ERBT may provide better histopathological quality. Tumor vaporization is performed in health care systems where reimbursement is adequate.

Keywords

Resection, transurethral Tumor extraction Obturatoriusreflex TURBT ERBT 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J.P. Struck, A. Karl, C. Schwentner, T.R.W. Herrmann und M.W. Kramer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • J. P. Struck
    • 1
  • A. Karl
    • 2
  • C. Schwentner
    • 3
  • T. R. W. Herrmann
    • 4
    • 5
  • M. W. Kramer
    • 1
  1. 1.Klinik für UrologieUniversitätsklinikum Schleswig-Holstein, Campus LübeckLübeckDeutschland
  2. 2.Urologische Klinik und PoliklinikLudwig-Maximilians-Universität München, Campus GroßhadernMünchenDeutschland
  3. 3.Urologische KlinikDiakonie Klinikum StuttgartStuttgartDeutschland
  4. 4.Klinik für UrologieKantonspital Frauenfeld, Spital Thurgau AGFrauenfeldSchweiz
  5. 5.Klinik für Urologie und Uro-OnkologieMedizinische Hochschule HannoverHannoverDeutschland

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