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

Abstract

OBJECTIVESTo 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 METHODSIn 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.RESULTSIn 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.CONCLUSIONThis 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.

The Health Economics of Bladder Cancer: An Updated Review of the Published Literature

“…A survey study of holmium:YAG vaporization as daysurgery management concluded that, though the initial costs of the technology are high, the long-term value is cost effective after only a few procedures [77]. Wong et al [78] offered office-based laser ablation (OLA) in place of inpatient cystodiathermy (IC) to 54 frail elderly patients (mean age 77 years, more than half with at least three comorbidities).…”

Hemangioma of the Prostatic Urethra: Holmium Laser Treatment

“…Its efficacy was proven in stone treatment and indications have been extended to urethral strictures and ureterocele. Application of the holmium laser in soft tissues includes bladder tumors and prostatic tissue ablation, performing tumor fulguration by a continued pulse starting at 1-1.4 J, 10-14 Hz frequency, and a depth of 0.4-0.6 mm [10] . With the knowledge of its use to treat vascularized lesions, we used the holmium laser technique in our patient for total removal of the hemangiomas and achieved a good tolerance, absence of adverse events and no postoperative complications.…”

Levobupivacaine intravesical injection for superficial bladder tumor resection—possible, effective, and durable. Preliminary clinical data

“…In addition, patients would prefer to avoid general anesthesia and the concomitant discomfort if sufficient alternatives are offered. In a study by Jonler et al [2] laser treatment was used for treatment of recurrent papillary bladder tumors with the sole use of local lignocaine gel. All patients stated that they would undergo the same treatment again if necessary.…”

“…Male sex and pre-operative dependency in daily living were major risk factors for decreased five-year survival [1]. It has recently been argued that intravesical local anaesthetic infiltration is a feasible option for pain elimination in patients undergoing resection of superficial bladder tumors [2][3][4]. However, suprapubic pain and lower urinary tract symptoms often mandate the use of post-operative analgesic regimens.…”