The Use of KTP laser for ablation of small, low grade transitional cell carcinoma of bladder in outpatient, office setting
Mohammad M. Siddiqui, M.D., Joseph A. Grocela, M.D., W. Scott McDougal, M.D., Sarah D. Psutka, M.D., Shahin Tabatabaei, MD.
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: Non-invasive, low grade transitional cell carcinoma (TCC) of bladder comprises the majority of bladder cancers. Although this type of bladder cancer has a low potential for invasion, it does recur and progress. This leads to various morbidities, including symptomatic hematuria and occasionally hydronephrosis. We review the use of KTP laser ablation for small, sub centimeter, low grade appearing TCC of bladder, as an outpatient, office based procedure.
METHODS: From September 2006 to March 2008, 120 patients with a known history of superficial, low grade bladder cancer were found to have sub-centimeter, recurrence of bladder TCC. Patients were between 55-82 years old. 45 were females. End fire, 600 micron, laser fiber with 15 watts KTP laser generator was used. Through flexible cytoscopy, and with local urethral lidocaine injection KTP laser tumor ablation was performed. 1-10 watts energy and lasing time of 20 - 400 seconds were used. Patients were discharged after void trial. The results reviewed retrospectively.
RESULTS: Average follow up is 18 months, with follow up range of 12-38 months. One to five small, sub centimeter tumors were ablated in one session. All patients were able to complete the procedure without any report of severe pain or discomfort. In 3 months cystoscopy, 110 patients had complete response without any persistent tumor. 10 patients had residual tumor that was resected under general anesthesia. They were found to have low grade, non invasiveTCC. 15 patients reported mild gross hematuria, without passage of clots. No patient required to be admitted for hematuria. 2 patients developed urinary tract infection. Overall, patients were satisfied with the procedure and 105 of them indicated their preference for this approach over procedure under general anesthesia.
CONCLUSIONS: Office based KTP laser ablation of small, low grade, recurrent bladder tumors is safe and can be done with minimal patient discomfort. Because of ablative nature of the procedure and lack of pathology specimen, we suggest to limit this procedure for recurrent, low grade appearing bladder TCCs. Further studies are underway to evaluate the efficacy of this approach.