Holmium YAG Photocoagulation: Safe and Economical Alternative to Transurethral Resection in Small Nonmuscle-Invasive Bladder Tumors.

Abstract

To analyze our experience in the treatment of recurrences of bladder tumor using Holmium-YAG (Ho:YAG) laser, assessing recurrence rates, tumor progression, degree of safety, and patient satisfaction, as well as the economic repercussions of the technique. The study included 109 patients between February 2013 and 2016, who had a superficial recurrence of bladder tumor. Patients were treated by Ho:YAG laser photocoagulation on an outpatient basis and under local anesthetic. Cytology and previous biopsy were collected. The number of tumors, size, time of technique, and any complications were recorded. Subsequently, urine culturing was carried out and we recorded the visual analogue scale, a satisfaction questionnaire, and possible complications. The economic cost of the procedures was calculated. Data were analyzed using a chi-square test for continuous variables and Student's t for independent samples for dichotomous qualitative-quantitative variables. We carried out 139 procedures on 25 women (20%) and 114 men (80%) with a mean age of 67.85 ± 10.41 years and 246 tumors were treated. The consultation time was 21.5 minutes and the photocoagulation time was 7 minutes (1-35). As intraoperative complications, two patients presented monosymptomatic hematuria without requiring treatment and there were no postoperative complications. The total recurrence rate at 6 months was 20%. A value ≤4 on the EVA scale was reported for 94.7% of the patients. The saving per procedure compared with transurethral bladder resection was calculated at €2,007.09. The treatment of small recurrences of bladder tumor by photocoagulation with Ho:YAG laser is a well-tolerated technique that offers an acceptable level of cancer control and a lower cost compared with transurethral resection.