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Purpose: To introduce transurethal partial cystectomy with a 2013 nm thulium laser as a treatment for paraganglioma of the urinary bladder in adults., Patients and Methods: Three patients with pheochromocytomas were treated transurethrally with a 2013 nm thulium laser under general anesthesia. A 2013 nm thulium laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together. Intraoperative fluctuation of blood pressure, preoperative values of 24-hour urine catecholamine (CA) and vanillylmandelic acid (VMA), and postoperative complications were observed, and postoperative followtwoups were performed., Results: All operations were successful. Operative time was 25 to 32 minutes. Perioperative blood pressure was stable in two cases while blood pressure fluctuated in the third case. When the entire tumor and the full-thickness bladder wall at the base were freed, blood pressure reverted to stability. All values of 24-hour urine CA and VMA were within normal limits postoperatively. Patients were followed for 7 to 9 months postoperatively with no recurrence. This series included highly selected patients who were treated by a single senior surgeon who is rich in experience in performing 2013 nm thulium laser procedures., Conclusions: To our knowledge, this is the first report of a 2013 nm thulium laser used to treat bladder pheochromocytoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and cut down the blood supply of the tumor, then peel it while blood pressure remains stable, thus completing partial cystectomy for bladder pheochromocytoma safely.

Objective: To investigate the characteristics of transurethral partial cystectomy with a 2 µm laser in diagnosis and treatment for the bladder submucosal lesions in adults., Methods: Nine patients with suspected pathological diagnosed bladder submucosal lesions in out-patient department were diagnosed and treated transurethral with a 2 µm laser under sacral block between August 2009 and December 2010. The diameters of tumors were 1.5 - 2.5 cm. A 2 µm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with bladder wall at the base were removed together and sent for pathological examination. The surgical procedures, intraoperative hemorrhage, intraoperative and postoperative complications were observed, pathological diagnosis and postoperative follow-up were performed., Results: All operations were successful. Mean operative time was 36.4 minutes (range 25 to 47 minutes), perioperative blood loss was minimal. There was no obturator nerve reflection and no hemorrhage detected after surgery. Postoperative pathological diagnosis included leiomyoma in 3 cases, pheochromocytoma in 3 cases, endometriosis in 1 case and metastatic bladder cancer in 2 cases., Conclusions: Transurethral partial cystectomy with a 2 µm laser can diagnose and treat bladder submucosal lesions. The procedures are effective and safe. Patients could get accurate pathological diagnosis without further painful and some bladder tumors can be treated by minimally invasive surgery.

Objective: To summarize and analyze the clinical features of bladder tumor patients who received transurethral partial cystectomy by 2 microm continuous wave laser, in 1 year post operation follow-up visits., Methods: From December 2007 to May 2008, 47 bladder carcinoma patients were treated with 2 microm laser transurethrally under sacral block. Operation characteristics, operation time, intraoperative hemorrhages and postoperative complications, and pathology staging of the tumor were observed and postoperative follow-up visits were performed., Results: All of the operation procedures were successful. The surgery time was 5 to 15 minutes. Blood loss in the operation was minimal. There was no obturator nerve reflection, and no hemorrhaging was detected after the operation. The pathological stages can be judged correctly with the obtained specimens. There was one case with peritoneum perforation. The patients received 12 to 17 months of postoperative follow-up visits, and there was no recurrence at the resection site. The survival rate was 100%., Conclusions: Transurethral partial cystectomy in the treatment of bladder tumor by 2 microm continuous wave laser is a safe, efficient and effective method. The tumor and all the basal part of bladder wall could be excised completely and the pathological stages can be judged correctly using these specimens to fulfill partial cystectomy for the treatment of bladder carcinoma.

Purpose: To our knowledge we established a new technique to vaporize and incise the full-thickness bladder wall and peel off the entire muscular layers with a 2 microm continuous wave laser to treat bladder carcinoma., Materials and Methods: Nine patients were treated transurethrally with a 2 microm laser under sacral block. This 2 microm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together and sent for pathological examination. Intraoperative hemorrhage and postoperative complications were observed, and pathological staging and postoperative followup were performed., Results: All operations were successful. Mean +/- SD operative time was 8.7 +/- 2.6 minutes (range 7 to 15) per patient. Perioperative blood loss was minimal. There was no obturator nerve reflection and no hemorrhage was detected after surgery. Bladder perforation occurred in 1 case. Pathological stage of the tumors was T1 and T2a. Patients were followed for 6 to 9 months postoperatively with no recurrence at the resection site. This series included highly selected patients treated by a single high volume surgeon., Conclusions: To our knowledge this is the first report of a 2 microm laser used to treat bladder carcinoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and peel it between detrusor muscle layers and outer loose connective tissues, thus completing partial cystectomy for bladder carcinoma.

Objective: To summarize the change of bladder tumor cells in irrigating solution after partial cystectomy by 2 microm continuous wave laser., Methods: From May 2008 to December 2008, a total of 30 patients of bladder cancer, the diameters of tumors from 0.5 to 3.0 cm. The diameter being regarded as the standard, patients were divided into two groups, 10 cases in group A (diameter < 2.0 cm) 20 cases in group B (diameter >or= 2.0 cm). The pre-operative pathologic histology diagnoses of all patients by biopsy were bladder urothelial carcinoma. Partial cystectomy by 2 microm continuous wave laser was given in operation. Due to the patients in group a with smaller tumors, the tumors were washed out of the bladder through the sheath of cystoscope directly. In group B, the larger tumors were cut into blocks by laser in the bladder, and washed out. After removing the tumors and debris, bladder irrigation was performed with about 150 ml solution for 5 times, then irrigating solution was centrifuged and numbered respectively before cellular pathology examination., Results: In group A, there were no tumor cells but epithelial cells and red blood cells could be seen in 8 cases. In the other 2 cases, a small amount of integrity and shape broken tumor cells could be seen in the No.1 and No.2 piece. There was no tumor cell in No.3, No.4, and No.5 pieces. In group B, tumor cells can be seen in No.1, No.2 and No.3 pieces in 14 cases, but cell density decreased gradually. There was no tumor cell in No.4, No.5 pieces, and tumor cells can be seen in No.1 to No.4 pieces for another 6 cases, and cell density also decreased gradually, there was no tumor cell in No.5 piece., Conclusion: After the surgery, 5 times of bladder irrigation in all cases of partial cystectomy by 2 microm continuous wave laser can reduce the remnants of the bladder tumor cells effectively.

Objective: To analyze the clinical characteristics of partial cystectomy in treatment of bladder tumor by 2 microm continuous wave laser., Methods: A total of 18 patients with 21 bladder tumors treated by 2 microm laser via transurethral under sacral block. The diameters of tumors were between 1-3 cm. In the operation, we vaporized and cut whole wall of bladder, dissected the muscular layers from connective tissue, and sent them for pathology inspection. We reviewed these following variables: operation time, blood loss, complications during and after the operation, pathology staging of the tumor and follow-up visit., Results: All the patients were tolerated in the operation. The mean operative time was (7.4 +/- 3.3) min (range, 5-12 min). Blood loss in the operation was minimal. No patient experienced an obturator nerve reflection or a hemorrhage after the operation. One case has urine leakage. The pathology staging of the tumors were as follows: T1 stage 15 cases, total 18 tumors; and T2 stage 3 cases, total 3 tumors. The followup periods were between 3 to 6 months, and the mean period was 4.5 months. There was no recurrence in situ., Conclusions: The 2 microm laser not only can vaporize and cut the wall of bladder finely, but also can dissect the muscular layers from connective tissue efficiently. So it can be partial cystectomy in the treatment of bladder tumor.

Objective: To analyze the clinical characteristics of 2 microm continuous wave laser vaporization resection for the treatment of bladder tumors., Methods: A total of 56 patients with 68 bladder tumors underwent 2 microm laser vaporization resection via a transurethral cystoscope under caudal anesthesia. In the operation, the wall of the urinary bladder was vaporized and cut, the muscular layers were removed, and then the specimens were sent for pathological inspection separately. The following variables were recorded: operation time, blood loss, complications during and after the operation, pathology staging of the tumors, and follow-up visit time., Results: All patients endured the operation. The mean surgery time was 8.8 +/- 3.3 minutes (range, 4 to 15 minutes). Blood loss was minimal, no patient experienced an obturator nerve reflection, or a hemorrhage after the operation. The pathology staging of the tumors were as follows: 40 cases (total 47 tumors) were T1 stage; 16 cases (total 21 tumors) were T2 stage. The follow-up periods were between 12 to 17 months, and the mean period was 14.5 months. Tumor recurrences were found in 3 cases, and one patients suffered two recurrences, the total recurrence rate was 5.3%. There was no primary recurrence., Conclusions: The 2 microm continuous wave laser is a new, safe and efficacious method for the treatment of bladder tumors. Because the 2 microm laser can vaporize and cut the muscular layers of the bladder finely, it can not only treat superficial bladder tumors efficiently, but also treat some types of invasive tumors of the bladder.