Implementation of a same-session outpatient diode laser ablation pathway for suspected recurrent low-grade NMIBC: feasibility, safety, and early outcomes

To evaluate feasibility, safety, tolerability, and early outcomes of a same-session "see-and-treat" pathway involving cold-cup biopsy followed by diode laser ablation during surveillance cystoscopy for suspected recurrent low-grade non-muscle-invasive bladder cancer (NMIBC).

We retrospectively analysed a prospectively maintained single-centre database of patients undergoing outpatient transurethral laser ablation (TULA) during surveillance cystoscopy. Eligible patients had one or two suspected low-grade papillary recurrences ≤ 1 cm. Procedures were performed without prior scheduling or intravesical anaesthesia, using intraurethral lidocaine gel. Biopsy was obtained whenever feasible.

Fifty-three patients underwent same-session ablation, completed in all without rescheduling, conversion to transurethral resection of bladder tumour (TURBT), or hospital admission; 50/53 (94.3%) underwent biopsy. Median pain score was 1 [IQR 1-2], and all patients preferred TULA over TURBT. One patient (1.9%) experienced immediate gross haematuria (Clavien-Dindo grade I). Among 52 patients with 30-day follow-up, 2 (3.8%) experienced gross haematuria (Clavien-Dindo grade I) and 2 (3.8%) developed urinary tract infections requiring antibiotics (Clavien-Dindo grade II); no Clavien-Dindo grade ≥ III events occurred. Biopsy identified pTa low-grade carcinoma in 18 (34.0%), pT0 in 27 (50.9%), carcinoma in situ (CIS) in 4 (7.5%), and intestinal-origin adenocarcinoma in 1 (1.9%). At 3 months, 46/49 (93.9%) had negative cystoscopy; only one had histologically confirmed urothelial recurrence (2.0%).

Same-session biopsy and diode laser ablation were feasible, safe, and well tolerated in selected patients. Biopsy provided clinically relevant information, including detection of unexpected CIS. Longer follow-up and comparative studies are required.