Holmium:YAG Laser Treatment of Recurrent Superficial Bladder Carcinoma: Initial Clinical Experience

Abstract

The absence of complications, high patient satisfaction, and ability to be used in the outpatient setting make the holmium:YAG laser an attractive alternative in the treatment of recurrent superficial cancer of the bladder.

Holmium:YAG laser vaporization of recurrent papillary tumours of the bladder under local anaesthesia

“…The procedure also caused an acceptable level of side-effects in a few patients, with only one having acute epididymitis. The present findings support those by others [2,12], that the holmium:YAG laser is clinically useful and that the lack of perceived pain or discomfort during treatment is an advantage for all patients, without selection.…”

“…The present study has no long-term follow-up but other studies report satisfactory results of laser vaporization in patients with superficial bladder cancer, with a mean follow-up of 14 and 24 months, respectively [2,11]. Only a long-term prospective randomized study can clearly determine whether standard TURBT or cystoscopic fulguration with electrocautery techniques is better than holmium:YAG laser vaporization, but the present study clearly indicates that the latter is feasible, easy and rapid, satisfying patients and providing a good alternative to other methods, with clear socio-economic benefits in both the shortand long-term.…”

“…Treating these recurrences might cause morbidity because of the frequent resections required for control, as these patients are often treated with electrocautery techniques for fulguration or transurethral resection of bladder tumour (TURBT) under general anaesthesia. Also, most of these patients are elderly with additional medical problems, and do not fulfil the criteria for outpatient or daycase surgery but require an overnight stay [2]. In patients with biopsy-confirmed superficial bladder cancer some institutions use a flexible cystoscope and electrocautery techniques for fulgurating recurrent superficial bladder tumours [1,3,4], an accepted treatment despite the lack of tissue for histology [3,5].…”

“…The disadvantages are the cost of the laser equipment and lack of tissue for histology (risking inadequate staging and tumour destruction). Several studies have evaluated different laser types for vaporizing bladder tumours [6][7][8][9][10] but only a very few have assessed the holmium:YAG laser for treating recurrent papillary tumours of the bladder under local anaesthesia [2,11,12].…”

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

“…Currently, there is insufficient data to predict progression rates, but recurrence rates after holmium laser treatment appear similar or less when compared with TURBT. 12 To date, results using the flexible cystoscope and Ho:YAG laser have been encouraging, 13 but larger studies with longer follow-up are needed. We report our clinical experience of Ho:YAG laser using a flexible cystoscope in the management of recurrent NMIBC under LA in the outpatient setting.…”