Introduction: Bladder leiomyomas are very rare, representing only 0.43% of all bladder tumors. Today the most common surgical treatment options for bladder leiomyoma are transurethral, open, laparoscopic and robotic resection. Due to very low incidence rate the assessment of efficacy and safety of different surgical techniques is yet to be done. We present a series of 6 cases of bladder leiomyoma treated with Thulium Fiber laser (TFL) en bloc resection. This report aims to investigate the feasibility, safety and efficacy of TFL en bloc resection for the treatment of bladder leiomyoma and to present our surgical technique.
Methods: From January 2019 up to present time 6 female patients with bladder leiomyoma (size 1.5cm - 4.0 cm) underwent TFL en bloc resection. All surgeries were performed with regular laser resectoscope (Richard Wolf GmbH, Knittlingen, Germany; Karl Storz, Tuttlingen, Germany), 600 µm laser fiber and TFL («FiberLase» IRE-Polus, Russia) operating at wavelength 1.94 µm. Laser settings - 1 J, 10 Hz, 10 W. Two out of six resected tumors were morcellated, three were removed with a bipolar loop, and one 2 cm tumor was extracted with Allis clamp. Intra- and postoperative complications were evaluated.
Results: All tumors were resected as a whole. Mean operative time was 24 min (10 - 40 min). Mean catheter time was 28 hours (24 - 48 hrs), mean length of hospital stay was 76 hours (72 - 96 hrs). No bladder perforation, obturator nerve stimulation, significant bleeding and postoperative complications were recorded. Morphological examination of resected tissues confirmed leiomyoma.
Conclusions: Based on our experience TFL en bloc resection is an effective and safe option for the surgical treatment of bladder leiomyoma. Moreover, it seems to provide fast recovery from the surgery.