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Flexible cystoscopy and Holmium:Yttrium aluminum garnet laser ablation for recurrent nonmuscle invasive bladder carcinoma under local anesthesia.

Syed, Haider A and Talbot, Nicholas and Abbas, Ahmed and MacDonald, Donald and Jones, Robert and Marr, Timothy J and Rukin, Nicholas J (2013) Flexible cystoscopy and Holmium:Yttrium aluminum garnet laser ablation for recurrent nonmuscle invasive bladder carcinoma under local anesthesia. Journal of endourology / Endourological Society, 27 (7). pp. 886-91. ISSN 1557-900X.

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Official URL: http://online.liebertpub.com/doi/abs/10.1089/end.2...

Abstract

PURPOSE

The management of recurrent nonmuscle invasive bladder cancer (NMIBC) post-transurethral resection has been based around electrocautery techniques, either under local or general anesthetic. We determine the long-term outcome of the management of NMIBC recurrences treated with Holmium:Yttrium Aluminum Garnet (Ho:YAG) laser ablation under local anesthetic with a flexible cystoscope.

PATIENTS AND METHODS

We performed a prospective analysis of 151 consecutive patients, undergoing treatment of 444 tumors, between 2006 and 2011 in a University Teaching Hospital. Median follow-up was 24 months (0-58 months). The primary outcome was local, on-site recurrence rates of NMIBC. The secondary outcome measure included off-site recurrence rates, complications, pain perception, and patient satisfaction.

RESULTS

Local, on-site recurrence rates after first treatment for all NMIBC disease were 10%. In patients with low risk NMIBC (G1/2, Ta), this reduced to around 4% post laser treatment. Higher recurrence rates (14%) were seen in those with high-grade (G3, T1) disease. Treatment was more successful with disease around the trigone, posterior and lateral bladder walls, with a significantly higher risk of recurrence for tumor around the ureteric orifice. The median time to local recurrence was 12 months and off-site recurrence was 25 months. Complication rates were low: dysuria (4.2%), frequency (1.5%), and hematuria (1.9%), with no episodes of bladder perforation. Visual analog pain scores were low, mean score 1 (range 0-7). The overall patient satisfaction was 100%.

CONCLUSIONS

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.

Item Type: Article
Subjects: WJ Urogenital system. Urology
Divisions: Planned IP Care > Urology
Emergency Services > Emergency Department
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Depositing User: Preeti Puligari
Date Deposited: 29 Aug 2014 10:19
Last Modified: 29 Aug 2014 10:19
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/654

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