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

Hermann, Gregers G.; Mogensen, Karin; Lindvold, Lars René; Haak, Christina Skovbølling; Hædersdal, Merete

doi:10.1002/lsm.22402

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…As a result of a high risk of recurrence, 1 , 2 patients with non-muscle-invasive bladder cancer (NMIBC) require long-term follow-up, including regular cystoscopy starting at 3 months after tumor resection. 1 Patients are usually followed up as outpatients, potentially with fulguration or laser removal of small lesions, 3 but they may require referral to the operating room for resection of larger recurrences. This procedure is performed under general anesthesia and requires patients to be hospitalized, which has resource and cost implications.…”

Section: Introductionmentioning

confidence: 99%

Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Zare

Grabe

Hermann

et al. 2018

RRU

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BackgroundThe aim of this prospective cohort study was to determine the feasibility of incorporating blue light flexible cystoscopy (BLFC) and biopsy/fulguration into routine outpatient follow-up of non-muscle invasive bladder cancer patients.MethodsThe study included patients with non-muscle-invasive bladder cancer (NMIBC) who were scheduled for routine follow-up. Hexaminolevulinate was instilled in the outpatient department, and the bladder was examined under white light and then with BLFC. Biopsies were taken from all suspicious lesions. Small tumors and suspicious lesions were fulgurated on site; patients with larger lesions were referred to the operating room for resection.ResultsThe study included 69 patients, with a mean age of 70 years (range 33–89 years) and a mean duration since NMIBC diagnosis of 8 years. Most patients had high-grade cancer at initial diagnosis (52/69) and were at high risk of recurrence (48/69). Two patients per hour could be assessed using outpatient BLFC. Preparation and instillation of hexaminolevulinate took less than 10 minutes per patient, and patients had an additional waiting time of 45–60 minutes following instillation, while the hexaminolevulinate solution was retained in the bladder before examination. Eleven patients had histologically confirmed tumors that were identified using both white light flexible cystoscopy and BLFC. An additional three patients had tumors that were identified by BLFC only: two with Ta tumors and one with carcinoma in situ. Of the 14 patients with confirmed tumors, 11 could be managed on site with fulguration, whereas three were referred to the operating room. No adverse events attributable to BLFC were reported.ConclusionRoutine outpatient management of patients with NMIBC using BLFC and on-site biopsy/fulguration is feasible, despite the additional time required for hexaminolevulinate instillation, and appears to allow early detection of recurrent lesions, which can be fulgurated without the need for hospitalization.

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Section: Introductionmentioning

confidence: 99%

Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Zare

Grabe

Hermann

et al. 2018

RRU

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“…This is the first report on the efficacy and usability of diode lasers in the treatment of bladder tumors. A 980 nm diode laser was chosen because of its significant optical absorption coefficient for hemoglobin (50 cm À1 ), which is sufficient to heat and ensure coagulation of blood vessels in tumors, thereby avoiding bleeding obscuring visualization [5].…”

Section: Discussionmentioning

confidence: 99%

“…Substantial healthcare resources and burden on patients could be spared if new technology could move the treatment of non-invasive bladder tumors into an outpatient or officebased setting. The authors have developed a method in which a diode laser is used to devascularize and vaporize intermediate-risk stage Ta low-grade tumors in this setting, without the use of sedation [5]. As sedation is not used, the patient can leave the outpatient department immediately after the endoscope (cystoscope) has been removed.…”

Section: Introductionmentioning

confidence: 99%

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

Hermann

Mogensen

Rosthøj

2018

Scandinavian Journal of Urology

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“…The tumor profile and safe margin were initially defined, and resection was then performed carefully, avoiding bladder perforation and excessive bladder wall distention. After removal of the bulging mass, hemostasis was achieved in the base lesions and surrounding mucosa, carefully with grasp and bite as previously reported (4)(5)(6).…”

Section: Patientsmentioning

confidence: 99%

“…Transurethral resection (TUR) has been shown to be an efficient and safe method for the treatment of NMIBC. However, NMIBC recurs in ~70% of patients post-TUR, and requires lifelong treatment (3)(4)(5)(6). Although, the recurrence rate of NMIBC is significantly decreased by TUR in combination with intravesical chemotherapy, the rate of cancer progression is not diminished (7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Bladder intracavitary hyperthermic perfusion chemotherapy for the prevention of recurrence of non-muscle invasive bladder cancer after transurethral resection

Cui

Wang

et al. 2017

Oncology Reports

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Abstract. Preventing the recurrence of non-muscle invasive bladder cancer (NMIBC) post-transurethral resection (TUR) remains challenging. The aim of the present study was to investigate the effectiveness and safety of bladder intracavitary hyperthermic perfusion chemotherapy (BHPC) for prevention of NMIBC recurrence post-TUR. Between December 2006 and December 2014, 53 patients with NMIBC who underwent TUR were randomly assigned to receive BHPC (BHPC group, 28 patients) or intravesical chemotherapy alone (chemotherapy group, 25 patients) at the Intracelom Hyperthermic Perfusion Therapy Center of Guangzhou Medical University Cancer Hospital (Guangzhou, China). BHPC was performed by combining perfusion-based hyperthermia with chemotherapeutic agent mitomycin C (MMC) in the bladder, and the chemotherapy group of patients received bladder MMC perfusion. The concentration of MMC in the perfusion fluid and serum were assessed at different time-points. Tumor recurrence, disease-free survival (DFS), and side-effects were recorded and compared between the 2 groups. Results revealed that BHPC was performed smoothly, at ~44̊C in the bladder cavity. Patients tolerated BHPC, and no side-effects were observed. Both BHPC and intravesical chemotherapy achieved a high MMC concentration in the bladder perfusion liquid, but low MMC concentration in the serum, although serum MMC concentrations in the BHPC group were significantly higher (P<0.05). The tumor recurrence rate was significantly lower (10.7 vs. 28.0%; P=0.02) and the DFS period was significantly longer (37±1.2 vs. 19±0.9 months; P=0.001) in the BHPC group than in the chemotherapy group. Our results demonstrated that BHPC is safe and effective for preventing NMIBC recurrence post-TUR and prolongs DFS.

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

Abstract: This diode laser technique may provide almost pain-free office-based treatment of low grade urothelial cancer using flexible cystoscopes in conscious patients. A prospective randomised study will be scheduled to compare the technique with standard TUR-BT in the operating theatre.

Cited by 9 publications

References 22 publications

Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

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

Bladder intracavitary hyperthermic perfusion chemotherapy for the prevention of recurrence of non-muscle invasive bladder cancer after transurethral resection

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