Outpatient diode laser treatment of intermediate-risk non-invasive bladder tumors without sedation: efficacy, safety and economic analysis.

Objective: This study aimed to validate a new method for outpatient diode laser ablation of bladder tumors without sedation or pain control.

Methods: Twenty-one patients with stage Ta low-grade intermediate-risk bladder tumors underwent photodynamic-guided laser ablation of their bladder tumors and 1 month later follow-up cystoscopy with photodynamic and IMAGE1 S™-guided biopsies. Pain was measured using a visual analog scale (range 0-10). Symptoms and worries about the future disease course were calculated using the Quality of Life Questionnaire for Non-Muscle-Invasive Bladder Cancer (range 0-100, high scores indicating worse symptoms or worry). Costs of outpatient laser treatment versus inpatient conventional bladder tumor resection in the operating theatre were compared.

Results: Patients had a median of three tumors (range 1-12). The median pain score was 1.0 (range 0-7) during laser ablation. Median quality of life scores were 24 (range 0-67) for symptoms and 42 (0-100) for worry. Two patients had minor hematuria and five had dysuria after laser therapy. Five patients (24%) had new Ta low-grade recurrence within 13 months that was biopsied and laser treated. No tumors progressed. Four patients had tumors identified using photodynamic diagnosis, and two had flat low-grade dysplasia identified using IMAGE1 S SPECTRA A and B and photodynamic diagnosis, none of which was seen using white-light cystoscopy. Outpatient laser treatment could save about €140,000 per million inhabitants versus inpatient bladder tumor surgery.

Conclusion: Fluorescence-guided diode lasers provide efficient and almost pain-free treatment of low-grade urothelial cancer in conscious patients and could reduce healthcare costs.