De-Intensification Strategies in Non-Muscle-Invasive Bladder Cancer: Outcomes and Cost Impact of In-Office Bladder...

Area of Science:

• Urology
• Oncology
• Minimally Invasive Surgery

Background:

• Non-muscle invasive bladder cancer (NMIBC) has high recurrence rates, necessitating frequent interventions.
• Current treatments like transurethral resection of the bladder (TURBT) can be resource-intensive.
• There is a need for efficient and safe alternatives for managing recurrent NMIBC.

Purpose of the Study:

• To evaluate the feasibility, safety, and oncological outcomes of in-office laser bladder tumor fulguration for NMIBC.
• To assess the economic impact of this novel protocol compared to conventional methods.
• To determine recurrence-free survival and complication rates.

Main Methods:

• A longitudinal study involving 65 patients with recurrent NMIBC from 2020-2025.
• Procedures performed in an outpatient setting using a flexible cystoscope and Holmium:YAG (Ho:YAG) laser under local anesthesia.
• Comparison of costs with traditional TURBT and analysis of recurrence rates and complications (Clavien-Dindo).

Main Results:

• A recurrence rate of 33.8% with 0% progression after a median follow-up of 20.3 months.
• High safety profile with 95.4% of procedures having no complications (only 4.6% Clavien-Dindo grade 1).
• Significant cost reduction: 89.7% savings versus 24h admission and 82.1% versus day-surgery models.

Conclusions:

• In-office laser fulguration is a safe, effective, and economically sustainable option for selected NMIBC recurrences.
• This approach optimizes hospital resources and minimizes anesthetic risks for comorbid patients.
• Favorable oncological control is maintained, offering a viable alternative to TURBT.