Clinical Efficscy And Learning Curve Of Front-Firing Green-Light Laser Enucleation Of Bladder Tumors In The Treatment Of Non-Muscle Invasive Urothelial Carcinoma Of Bladder Diameter Less Than 3cm

Objective: to investigate the clinical safety,efficacy and learning curve of front-firing green-light laser enucleation of bladder tumors(FGLEBT)diameter in the treatment of < 3 cm non-muscular invasive bladder urothelial carcinoma(NMIBUC).Methods: the clinical data of 110 patients with diameter <3cmNMIBUC who were admitted to the urology department of the second people’s hospital of guangdong province and received surgical treatment from March 2013 to March 2018(53 patients in FGLEBT group and 57 patients in TURBT group)were retrospectively analyzed,and the clinical data such as general data,postoperative evaluation index and postoperative recurrence rate between the two groups were compared and analyzed.Use the cumulative and analytical method(CUSUM)to help evaluate the FGLEBT learning curve.Results: the operation time of FGLEBT group was shorter than that of TURBT group [(21.49±6.46)min vs(29.47±10.49)min,P=0.001],and the HB reduction of FGLEBT group before and after surgery was significantly lower than that of TURBT group [(1.36±4.98)g/L vs(6.35±7.56)g/L,P=0.001].The duration of postoperative bladder irrigation and postoperative hospitalization in the FGLBT group were all lower than that in the TURBT group [(25.75±7.58)h vs(30.70±10.57)h,P =0.007;(3.96±1.43)d vs(5.18±1.97)d,P =0.001].Postoperative pathological features of FGLEBT group were higher than that of TURBT group [45 cases(84.9%)vs 39 cases(68.4%),P =0.042],and TURBT group had more obturator nerve reflex than that of FGLEBT group [7 cases(12.3%)vs 0 cases(0%),P =0.013].Kaplan-meier survival analysis showed no statistically significant difference in relapse-free survival between the two groups(=1.36,P=0.244).According to CUSUM accumulation and curve,FGLEBT learning requires about 13 surgeries.Conclusions :(1)FGLEBT treatment of NMIBUC with diameter <3cm is clinically feasible.(2)Compared with TURBT,the operation is safe and effective,with a series of advantages such as less bleeding,shorter operation time and faster postoperative recovery.It is worthy of extensive clinical promotion.(3)The learning phase of FGLEBT requires about 13 surgical operations.