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Comparative Efficacy of Transurethral Laser Ablation Versus Conventional Methods in the Management of Recurrent
Mahmoud D Srour1, Ali Mohamed1, Sunil Mathur1
1Urology, Great Western Hospitals NHS Foundation Trust, Swindon, GBR.
Introduction:
Non-muscle-invasive bladder cancer (NMIBC) is characterised by a high recurrence rate, necessitating frequent intervention. While conventional transurethral resection of bladder tumour (TURBT) under general anaesthesia is standard, it carries inherent risks. Transurethral laser ablation (TULA) performed under local anaesthesia in an outpatient setting presents a viable, minimally invasive alternative, yet robust comparative efficacy data remain limited. This study aimed to compare the effectiveness of TULA and TURBT in preventing early tumour recurrence and to provide practical insights for implementing an outpatient TULA service.
Methods:
This retrospective cohort study included patients with recurrent NMIBC treated with either TULA or TURBT. Patient selection for the comparative analysis was restricted to those with recurrent lesions sized less than 1 cm. The TULA procedures were performed under local anaesthesia using a holmium:yttrium-aluminium-garnet (Ho:YAG) laser (Cook Medical, Ireland) and a compatible fibre. Key outcomes included the tumour recurrence rate at the first follow-up cystoscopy. Complications were assessed retrospectively over a 30-day period.
Results:
A total of 97 patients were included (TULA: 51; TURBT: 46). Baseline characteristics (age, sex, and risk stratification) were comparable between the groups (p>0.05). No statistically significant difference in tumour recurrence rates was observed at the first follow-up cystoscopy: 30 patients (58.8%) in the TULA group and 27 patients (58.7%) in the TURBT group exhibited no recurrence. Furthermore, TULA demonstrated no immediate post-procedure complications requiring hospital admission. Implementation of the outpatient TULA service, prioritising staff training, safety, and a robust governance framework, proved successful in our centre.
Conclusion:
TULA performed under local anaesthesia demonstrates possible comparable efficacy to TURBT in preventing early tumour recurrence, underscoring its potential as a reasonable alternative for managing small, recurrent NMIBC, particularly for patients at higher risk of complications from general anaesthesia. Successful establishment of an outpatient TULA service, guided by clear operational and safety protocols, enhances efficiency. Larger prospective multicentre trials with longer follow-up are warranted to fully validate these findings.
