全層膀胱腫瘤切除術保留輸尿管開口：銩雷射整塊切除技術之應用

唐慈翊^1-2、阮雍順^1,2

高雄醫學大學附設醫院¹泌尿科;

 高雄醫學大學醫學院²泌尿學科

Thulium Laser En Bloc Resection of Bladder Tumor: A Technique for Ureteral Orifice Preservation

Tsz-Yi Tang^1-2, Yung-Shun Juan ^1,2

¹Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;

²Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan

Case Report 

            A 67-year-old man with no significant medical history presented with several days of intermittent gross hematuria. Ultrasound imaging revealed a suspicious bladder tumor located in the left trigone. Laboratory findings were unremarkable. Abdominal computed tomography (CT) confirmed a 1.85 cm bladder tumor in the left lateral trigone, involving the ureterovesical orifice, without associated hydronephrosis. To preserve the ureteral orifice, En-bloc laser resection of the bladder tumor was planned. Cystoscopic examination revealed a large, broad-based papillary tumor covering the left orifice. En bloc resection was performed by Thulium laser (Vela laser), excising the tumor along with the entire mucosal layer while preserving the ureteral orifice (Figure 2). Postoperative evaluation showed no hydronephrosis or acute kidney injury. Pathology showed non-invasive papillary urinary carcinoma, high grade. No recurrence bladder tumor was found 3 months after operation.

Conclusion

This case highlights the effectiveness of laser En-bloc resection for bladder cancer. This technique enabled precise excision with preservation of the ureteral orifice, minimized perforation risk, and avoided obturator nerve reflex. Given its benefits, including enhanced safety, decreased complication rates, and potential ease of operation, En-bloc laser resection could be considered as a preferred standard for bladder tumor resection, especially when patients have the financial means to support this approach.