Perioperative and oncological outcomes of thulium laser-ERBT versus conventional TURBT in non-muscle invasive bladder cancer: a metaanalysis of 2,934 patients

Q: What clinical question does the meta-analysis address?

It compares perioperative safety, surgical quality, and oncological outcomes of thulium laser en bloc resection (TmL-ERBT) versus conventional TURBT in non-muscle-invasive bladder cancer.

Q: How many studies and patients were included, and how were they distributed?

Fourteen studies were included, totaling 2,934 patients: 1,395 received TmL-ERBT and 1,539 received TURBT.

Q: Which perioperative outcomes favored TmL-ERBT?

TmL-ERBT shortened catheterization time, postoperative irrigation time, and hospitalization time, and improved safety indicators such as obturator nerve reflex, bladder perforation, and bleeding.

Q: Did TmL-ERBT improve recurrence-free rates, and for which follow-up durations?

Recurrence-free rates were significantly better at 3 months and 12 months, while no significant differences were reported at 24 months and at follow-up of 30 months or more.

Sep 22, 2026

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Thulium laser en bloc resection of bladder tumors (TmL-ERBT) is evaluated against conventional transurethral resection (TURBT) for non-muscle-invasive bladder cancer (NMIBC). A systematic search of PubMed, Embase, Web of Science, and Cochrane Library identified comparative studies, analyzing perioperative complications, oncological outcomes, and surgical quality with heterogeneity assessment (I², subgroup analysis) and risk of bias (ROB2) plus evidence certainty grading (GRADEpro GDT). Fourteen studies with 2,934 patients showed shorter catheterization, irrigation, and hospitalization times, improved safety, and better recurrence-free rates at 3 and 12 months.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

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Abstract

Lasers in Medical Science (2026) 41:63 [https://doi.org/10.1007/s10103-026-04856-x](https://doi.org/10.1007/s10103-026-04856-x) RESEARCH Perioperative and oncological outcomes of thulium laser-ERBT versus conventional TURBT in non-muscle invasive bladder cancer: a metaanalysis of 2,934 patients Dong Chen1 · Zhongbao Zhou2 · Guangzhu Wei1 · Fengbo Zhang1 Received: 9 November 2025 / Accepted: 8 March 2026 © The Author(s) 2026 Abstract Thulium laser en bloc resection of bladder tumors (TmL-ERBT) represents a novel surgical approach for non-muscleinvasive bladder cancer (NMIBC), but its comparative advantages over conventional transurethral resection (TURBT) remain controversial. This meta-analysis aimed to evaluate perioperative safety, surgical quality, and oncological outcomesofTmL-ERBT versus TURBT. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library identified comparative studies ofTmL-ERBT versus TURBT. Perioperative complications, oncological outcomes, and surgical quality indicators were analyzed. Heterogeneity was assessed using I² statistics and subgroup analysis. The study quality was evaluated using the ROB2 tool. Evidence certainty was graded using the GRADEpro GDT. Fourteen studies comprising 2,934 patients (TmL-ERBT: n = 1,395; TURBT: n = 1,539) were included. TmL-ERBT demonstrated significant advantagesin perioperative outcomes: shorter catheterization time (MD: -0.71 days, P = 0.001), reduced postoperative irrigation time (MD: -8.79 h, P = 0.0004), and decreased hospitalization time (MD: -0.63 days, P = 0.006) . Operation duration showed no significant difference (MD: -2.66 min, P = 0.33) . Safety outcomes favored TmL-ERBT with virtual elimination of obturator nerve reflex (OR: 0.04, P < 0.00001), reduced bladder perforation (OR: 0.26, P < 0.00001), decreased bleeding (OR: 0.10, P < 0.0001), and improved detrusor muscle presence (OR: 3.22, P = 0.03) . Overall complication rates were comparable (OR: 0.75, P = 0.28) . TmL-ERBT significantly improved recurrence-free rates at 3 months (OR: 1.70, P = 0.02) and 12 months (OR: 1.45, P = 0.04), but no difference at 24 months (OR: 1.03, P = 0.82) and ≥ 30 months (OR: 0.85, P = 0.13) than TURBT. Subgroup analyses revealed the advantages of TmL-ERBT were most pronounced in low-risk, smaller, solitary tumors. TmL-ERBT demonstrated superior perioperative outcomes, enhanced safety with reduced complications compared with conventional TURBT. These findings supported TmL-ERBT as a promising alternative for NMIBC management. Keywords Thulium laser · Non-muscle-invasive bladder cancer · En bloc resection · Perioperative outcomes · Recurrence-free rate 􀀍 Fengbo Zhang [drzhangfb@163.com](drzhangfb@163.com) Dong Chen [15001368088@163.com](15001368088@163.com) Zhongbao Zhou [346894383@qq.com](346894383@qq.com) Guangzhu Wei [doctorwgz@126.com](doctorwgz@126.com) 1 Department of Urology, Beijing Luhe Hospital, Capital Medical University, Beijing, China 2 Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China Introduction Bladder cancer ranks among the most prevalent malignancies ofthe urinary system worldwide, and non-muscle-invasive bladder cancer (NMIBC) accounts for approximately 75–80% of newly diagnosed bladder cancer [1] . Transurethral resection of bladder tumor (TURBT) has served asthe gold standard for diagnosis and treatment of NMIBC [2] . However, conventional TURBT has limitations, including fragmented resection, thermal artifacts, and inadequate detrusor muscle sampling, potentially leading to understaging and compromising pathological assessment [3, 4] . Perioperative complications such as bladder perforation, 1 3 obturator nerve reflex, and irrigation-related issues are concerns [5] . Most critically, incomplete resection and tumor cell reimplantation during the procedure may contribute to the high recurrence rates [6] . Beyond surgical improvements, the landscape of NMIB

FAQs

What clinical question does the meta-analysis address?

It compares perioperative safety, surgical quality, and oncological outcomes of thulium laser en bloc resection (TmL-ERBT) versus conventional TURBT in non-muscle-invasive bladder cancer.

How many studies and patients were included, and how were they distributed?

Fourteen studies were included, totaling 2,934 patients: 1,395 received TmL-ERBT and 1,539 received TURBT.

Which perioperative outcomes favored TmL-ERBT?

TmL-ERBT shortened catheterization time, postoperative irrigation time, and hospitalization time, and improved safety indicators such as obturator nerve reflex, bladder perforation, and bleeding.

Did TmL-ERBT improve recurrence-free rates, and for which follow-up durations?

Recurrence-free rates were significantly better at 3 months and 12 months, while no significant differences were reported at 24 months and at follow-up of 30 months or more.

Sep 22, 2026

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