Mihály Zoltán Attila, Mănescu Mihai Răzvan, Călin Neiculescu, Mihály Orsolya and Coman Ioan
Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.
We evaluated the results of laser ablation of recurrent low stage non muscle invasive bladder tumors.
MATERIALS AND METHODS:
The study included 14 patients with a recurrent superficial papillary tumor within 12 month of endoscopic resection. Patients underwent Holmium laser ablation of the tumors with an end-fire noncontact fiber which allows a penetration depth up to 0,4 mm per pulse, under spinal anaesthesia. They received early instillation of 50 mg Epirubicin and were discharged home first day after surgery without a catheter. Patients were reevaluated by cistoscopy after 3, 6 and 12 months to evaluate tumor recurrence.
The surgery time was 5 to 25 minutes. Laser coagulation allowed minimally invasive ablation of tumors up to 2.5 cm in size. Blood loss in the operation was negligible and not detected after the operation. There was no obturator nerve reflection. The incidence of recurrence at 12 months was 21%.
Because there is no tissue available for pathologic inspection, the optimal candidate for laser therapy is the patient with recurrent, low-grade lesions whose hystological stage and grade is already known. In papillary tumors the pathological stages can be judged correctly with the obtained specimens by resecting the tumor at the basis. The depth of penetration of a laser beam is a critical factor in determining the therapeutic potential and risks of treatment.
There were no complications and the recurrence rate was similar to that of transurethral resection. Treatment should be under direct visualization and should discontinue as soon as protein denaturation is evident by the white appearance of the treated tissue. Persistence after this occurs risks extravesical injury.