TURBT – Holmium laser en-bloc resection of the Bladder tumor (Ho-ERBT)

Last updated: May 18, 2026

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In this topic, I will classify the pros and cons of Ho-ERBT (Holmium laser En-Bloc Resection of Bladder Tumor) compared with the conventional TURBT (Transurethral Resection of Bladder Tumor). Let’s start with understanding the conventional operation first.

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The conventional TURBT involves passing a scope via the urethra and using a small electrical surgical knife to scoop the bladder tumor piece by piece — sometimes requiring hundreds of scoops in a single operation. Each scoop risks bleeding and the procedure carries a risk of bladder perforation due to the “Obturator reflex”: the electrical current can trigger an involuntary lower body muscle contraction during cutting, which can result in bladder perforation and potential emergency open surgery. Ho-ERBT eliminates this risk because the Holmium laser does not trigger an obturator reflex.

Ho-ERBT uses Holmium YAG laser technology to excise the entire bladder tumor in a single en-bloc specimen — rather than piece by piece as in conventional TURBT. This provides a superior pathological specimen with intact deep margins for accurate staging.

Ho-ERBT’s Pros

1. Less bleeding – Holmium laser resects and coagulates simultaneously, reducing intraoperative blood loss
2. Shorter hospitalization – confirmed reports show Ho-ERBT patients are discharged significantly faster (2 days vs. 4 days for conventional TURBT)
3. Lower risk of bladder perforation – no obturator reflex with laser energy
4. Less postoperative irritative urinary symptoms
5. Better pathological specimen – en-bloc resection preserves the detrusor muscle layer for accurate T-staging

Ho-ERBT’s Cons

1. Steep learning curve – at least 25 cases are required to achieve adequate proficiency in Ho-ERBT
2. Specialized equipment required – Holmium laser systems are expensive and not available in all centers, making the procedure more costly than conventional TURBT

In conclusion, Ho-ERBT is one of the best endoscopic bladder tumor removal operations available today and requires a well-trained urologist with dedicated laser equipment. Any questions, you should discuss with your trusted urologist.

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Frequently Asked Questions About TURBT and Ho-ERBT

What is the difference between TURBT and Ho-ERBT?

TURBT (Transurethral Resection of Bladder Tumor) is the conventional endoscopic bladder tumor removal technique that uses electrical energy to scoop the tumor in multiple fragments. Ho-ERBT (Holmium laser En-Bloc Resection of Bladder Tumor) uses Holmium YAG laser technology to excise the entire tumor as a single en-bloc specimen. The en-bloc approach provides a superior pathological specimen with intact deep margins, enabling more accurate tumor staging compared to the fragmented specimens from conventional TURBT.

What are the advantages of Ho-ERBT over conventional TURBT?

Ho-ERBT offers several clinical advantages: less intraoperative bleeding (laser coagulates simultaneously with cutting), shorter hospitalization (2 days vs. 4 days), no risk of obturator reflex-related bladder perforation (since laser energy does not trigger this reflex), fewer postoperative irritative urinary symptoms, and superior pathological specimen quality for staging. These benefits make Ho-ERBT increasingly preferred at centers with the required expertise and equipment.

Is Ho-ERBT available at Bangkok Hospital?

Yes, Ho-ERBT and advanced endoscopic bladder tumor resection are available at Bangkok Hospital Headquarters under Dr. Soarawee Weerasopone, a urologic oncologist trained in minimally invasive and laser urological surgery. The procedure requires specialized Holmium laser equipment and a surgeon with dedicated training, both of which are available at the center. For bladder tumor concerns, early specialist evaluation is recommended.

If you have been diagnosed with a bladder tumor or would like a urologic oncology consultation, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.