Flexible Cystoscopy and Holmium:Yttrium Aluminum Garnet Laser Ablation for Recurrent Nonmuscle Invasive Bladder Carcinoma Under Local Anesthesia

Abstract

Flexible cystoscopy and Ho:YAG laser therapy should be considered as a first line treatment option for the management of recurrence in low-grade NMIBC (G1/2, Ta/1) throughout the bladder, except around the ureteric orifices. For those with high-grade disease (G3), the recurrences rates are increased, but the procedure still offers an acceptable recurrence rate. It provides good local disease control, low complications, patient acceptability and tolerance.

Office‐based transurethral devascularisation of low grade non‐invasive urothelial cancer using diode laser. A feasibility study

“…With regards to recurrence rates, laser TUR-BT appears to be equal to TUR-BT using diathermy [12,13]. Lately, thulium laser TUR-BT of non-invasive urothelial bladder tumours in selected patients was reported showing a recurrence rate of 14.5% during a 16 month follow-up period [14] and a 2 year overall recurrence rate of 48% after holmium laser TUR-BT [6]. Similar results may be found after golden standard TUR-BT with GA but data comparing laser TUR-BT and conventional TUR-BT are not yet available.…”

“…Only four studies have used flexible cystoscopies for laser TUR-BT [6,7,16,17]. However, in contrast, these procedures have been done either during GA or sedation, or without a concurrent biopsy for histology.…”

“…However, this method has mostly been confined to patients unfit for GA, and presenting with solitary or only a few small tumours. As routine simultaneous biopsy is rarely used with this technique and therefore there is no histological diagnosis of the tumour, there are concerns that progression may be overlooked. This has limited the use of diathermy or laser in office‐based TUR‐BT.…”

Outpatient diode laser treatment of intermediate-risk non-invasive bladder tumors without sedation: efficacy, safety and economic analysis

“…Other investigators have reported recurrence rates up to 73% 3 months after inpatient yttrium aluminum garnet (YAG) laser treatment of non-muscle-invasive bladder cancer, including T1 disease [15]. A 6% progression rate in the 2 years after outpatient holmium:YAG laser treatment has been reported in patients with T1 high-grade tumors, compared with no progression in those with Ta low-grade tumors [16]. In the absence of substantial evidence on the efficacy of outpatient laser treatment of bladder cancer, only Ta lowgrade disease was treated in this study, because the risk of progression is low in these tumors.…”

The role of lasers in modern urology

“…BC ablation is also an option especially in low-grade non-muscle invasive bladder cancers (NMIBC) in elderly patients. The procedure seems to be effective, well-tolerated, associated with a low risk of complications and can be successfully delivered in an outpatient setting [ 65 , 66 ]. In addition, hexylaminolevulinate (HAL) photodynamic diagnosis (PDD)-assisted TURBT is also worth mentioning.…”