Holmium Laser En-bloc Resection of Bladder Tumor (HoL-ERBT) with Moses 2.0: A Comparison to Conventional Bipolar Transurethral Resection of Bladder Tumor (TURBT)

Introduction Bladder tumor staging and treatment is traditionally performed by transurethral resection (TURBT) with a bipolar resectoscope. Prior studies have shown that en-bloc resection of bladder tumor may offer improved hemostasis and tissue sampling. Objectives: To compare high-power pulse modulation holmium laser en-bloc resection of bladder tumor (HoL-ERBT) outcomes to traditional bipolar TURBT. Design and Methods: We performed retrospective review of patients who underwent HoL-ERBT using high-power pulse modulation from Jan 2020 to Aug 2023. We identified similar patients who had undergone bipolar TURBT by propensity score matching based on age, sex, BMI, and tumor size. Preoperative, intraoperative, and postoperative characteristics were compared between the two groups. Results: We identified 14 HoL-ERBT and 14 TURBT patients for a total of 28 patients. There were no differences between the groups with regards to age, BMI, or sex. Number of tumors, tumor type, total tumor size, and tumor site did not differ significantly between the two groups. HoL-ERBT patients were more likely to have primary rather than recurrent tumors (86 vs 50%, p=0.043). Median operative time was longer in the HoL-ERBT group (70.5 vs 55.5 min, p=0.104). HoL-ERBT patients had similar rates of detrusor sampling, postoperative catheterization, foley duration and length of stay. Conclusions: Our study demonstrates the safety and efficacy of high-power pulse modulation HoL-ERBT for bladder tumors compared to traditional bipolar TURBT. Future studies w