A prospective trial of flexible cystodiathermy for recurrent transitional cell carcinoma of the bladder

The flexible cystoscope has a proved role in the followup of patients with transitional cell carcinoma of the bladder but the full extent of its therapeutic role has yet to be defined. We analyzed 171 flexible cystodiathermies to assess patient tolerance and treatment success. Potential cost savings were also analyzed.

All patients with single or multiple small papillary (Ta) recurrences at followup flexible cystoscopy were treated with flexible cystodiathermy. Plain lubricating gel was used and no other analgesia was prescribed. A visual analog pain scale was completed by the patient after the procedure and an observer rating of discomfort was recorded. Followup for efficacy of treatment was performed.

A total of 103 patients were treated with cystodiathermy during the last 3 years. Median followup was 21 months (range 12 to 42). Of the patients 52 (50.5%) had no recurrence of transitional cell carcinoma after treatment and 51 (49.5%) required treatment for recurrence. Only 13 patients (12.6%) had recurrences at or close to the original tumor site. Pain scales indicated that the procedure was well tolerated and all patients agreed to undergo it in the future if required. Estimated cost savings were approximately $66,500 per 100 patients.

Flexible cystodiathermy is a well tolerated and efficacious treatment for recurrent small papillary (Ta) transitional cell carcinoma of the bladder. Since transitional cell carcinoma of the bladder frequently occurs in an elderly and often unfit population treatment that avoids general anesthetic offers considerable advantages.