Transurethral laser ablation for recurrent non-muscle-invasive bladder cancer

The most common form of bladder cancer is transitional cell carcinoma. Non-muscle-invasive transitional cell carcinoma is classified as stage Ta when it is confined to the uroepithelium and stage T1 when it has spread into the connective tissue layer between the urothelium and the muscle wall. Non-muscle-invasive transitional cell carcinomas usually appear as small growths from the bladder lining. They can be graded from G1 (low grade, least aggressive) to G3 (high grade, most aggressive). Carcinoma in situ consists of aggressive cancer cells that spread within the surface lining of the bladder and appear flat. It is more likely to recur after treatment.

NICE's guideline on bladder cancer describes its diagnosis and management. Surgical interventions for non-muscle-invasive transitional cell carcinoma include transurethral resection, in which malignant tissue is removed with an electrocautery device during cystoscopy. Bacillus Calmette–Guérin (BCG) vaccine or chemotherapy drugs may be put directly into the bladder, either as treatments in themselves or as adjuvant therapy after transurethral resection. Cystectomy may also be necessary in some patients.

This procedure is most often used for very small, recurrent bladder tumours. It is usually done as day surgery using local anaesthesia. A flexible cystoscope is passed through the urethra into the bladder. The tumours are then ablated using a laser fibre contained in the cystoscope.

If there is a lot of bleeding after the procedure, a urinary catheter may be inserted to allow bladder irrigation.

Adjuvant intravesical chemotherapy may be offered after the procedure.

The aim is to destroy the tumour with less morbidity than is seen with conventional treatments. The suggested benefits over cystodiathermy include less bleeding and reduced pain.