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

Abstract

Objectives: To evaluate holmium:YAG laser vaporization of papillary tumours of the bladder, focusing on surgical technique, patients' satisfaction, complications and cost-effectiveness when using the technique under local anaesthesia as an outpatient procedure.

Patients and methods: In all, 52 consecutive patients with recurrent papillary tumours of the bladder were scheduled for holmium:YAG laser vaporization under local anaesthesia using a flexible cystoscope. The number of papillomas and total operative duration was recorded. Patients and surgeons were asked to complete a questionnaire about the procedure.

Results: In all, 197 papillomas were successfully vaporized in 88 operations, with a median operative duration of 15 min (5 min per papilloma) and no patient needed treatment under general anaesthesia. Most patients (86%) had no pain (as reported during standard cystoscopy) and none of the procedures was stopped because of pain. All patients would undergo the treatment again, compared with a standard transurethral resection of bladder tumour. The five surgeons rated the procedure as easy in most patients (78%) and difficult in a few (6%). The total cost for the outpatient procedure was less than that for standard treatment.

Conclusion: This study clearly indicates that holmium:YAG laser vaporization of superficial bladder tumours is feasible, easy and fast, with a high degree of patient satisfaction, and it seems to be an attractive alternative to standard treatment. The procedure has some clear positive socio-economic perspectives in both the short- and long-term.