Holmium Laser En Bloc Transurethral Resection of Bladder Tumor in Pediatric Urothelial Carcinoma: Surgical Technique

Abstract

Clinical History and Diagnosis:

A 14-year male presented with history of frequency of urination for last 5 months. Ultrasound abdomen pelvis showed 1.7 × 1.5 cm papillary lesion in urinary bladder near left ureteric orifice and it was confirmed in a contrast enhanced CT abdomen pelvis. Urine cytology was negative, and we planned for Cystoscopy and Holmium laser en bloc transurethral resection of bladder tumor under general anesthesia.

Intervention:

We used a 17 Fr Cystoscope and a 550 micron Holmium laser fiber stabilized over a 5 Fr open-ended ureteral catheter with the setting of 1.5 J and 30 Hz. Lumenis 100 w Holmium laser machine with long pulse width was used for better hemostasis. The initial incision was made 5 mm away from the tumor stalk at 6 o'clock position till the detrusor muscle was reached, and then we progressed toward the 12 o'clock potion using the beak of the cystoscope to lift the tumor and progress with the retrograde resection. The tumor was retrieved using an Alligator grasping forceps.

Results:

A 14 Fr 2 way Foley catheter was placed. Total operative time was 7 mins. The Frozen section confirmed the tumor as carcinoma and the patient received Intravesical Mitomycin 40 mg in 20 mL of sterile water. He was discharged the same day, and the Foley catheter was removed the next day. The Final pathology showed Urothelial carcinoma urinary bladder cTa low grade <3 cm, low risk.

Follow-up:

The surveillance flexible cystoscopy at 3 and 12 months did not show any recurrence. The patient is on yearly Ultrasound follow up without any recurrence in 3 years.

The source of work or study:

Apollo Multispecialty Hospitals, Kolkata, India.

Author Disclosure Statement:

The authors declare that they have have no conflicts of interest during the last 3 years related to this study. No funding, grants, or other financial support was received for this work. The authors affirm that they have no financial relationships, affiliations, or personal interests that could influence the research or its outcomes. The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The authors declare that there are no conflicts of interest related to the place of work or affiliation. The study was conducted independently, and no institutional or organizational influences have impacted the research design, data analysis, or interpretation of results.

Runtime time of video: 4 mins 58 secs.