With non-muscle invasive bladder cancer (NMIBC) posing a significant burden on urological departments, alternative ways of safely and effectively managing these patients with a minimally invasive approach is desirable. As rates of recurrence are high but progression rates low, and in an increasingly elderly and frail population, this paper assesses the feasibility of outpatient laser ablation (OLA) with and without photodynamic diagnosis (PDD), compared to conventional techniques. Seventy-four procedures (44 white light, 30 PDD) in 54 patients were analysed with a mean patient age of 77 years. Extra tumours were found in 21% of PDD cases versus white light, with recurrence rates at three and twelve months of 10.6% and 65.1%, dropping to 4.3% and 46.9% when combined with PDD. Four patients had procedures whilst on warfarin and complications for the whole group were minimal. A cost-effectiveness analysis model also showed the technique to be cheaper than cystodiathermy in the short and medium term. It may also help release extra theatre capacity. This study highlights the need to tailor NMIBC management to the individual, essentially balancing the risks of aggressive tumour control with morbidity. In an elderly population, they have shown the technique in this small cohort to be safe, although the recurrence rates despite PDD are still high. However, this was without the use of adjuvant intravesical chemotherapy. Cystodiathermy under local anaesthetic has been proven to be effective in other studies, with 12% finding it too painful but no comparative studies have yet been performed. The site and stage of the tumour can also limit the technique and no pathological specimens were obtained which may allow progression to go unnoticed. However, for selected patients, this technique shows promise in controlling NMIBC disease with minimal discomfort and patient hassle.
Reducing the burden of NMIBC: outpatient laser management in morbid patients
Reviewed by Mark Harris
Outpatient laser ablation of non-muscle-invasive bladder cancer: is it safe, tolerable and cost-effective?
