The Use of KTP Laser Tumor Ablation for Management of Extensive Transitional Cell Carcinoma of Bladder (Initial Results)
Shahin Tabatabaei, MD, Sarah D. Psutka, M.D., Mohammad M. Siddiqui, M.D..
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: Transurethral resection of bladder tumor (TURBT) with electrocautery is a standard treatment for management of superficial bladder tumors. Occasionally however, because of the size, location and/or extent of bladder tumor, TURBT is not technically feasible. We investigated the application of KTP laser as a last resort before open surgery in this group of patients.
METHODS: Between October 2004 to December 2008, 22 patients were selected for KTP laser bladder tumor ablation. They were betwen 35 to 86 years old. Pathological stages were Ta, T1, and T2. 8 patients were female. 4 patients with T2 disease had intractable, severe hematuria that was not amenable to electrocoagulation. In these patients the procedure was offered as a last resort for palliation, since they were not medically fit for more aggressive treatment. In 4 patients the procedure was done because of extent and/or location of the bladder tumor.
The 80 Watt KTP laser (532nm) GreenLight TM machine was used in all these patients. Normal Saline was used for bladder irrigation and 23 Fr continuous cystoscope sheath with 30 and 70 degree lenses were used. A 600 micron, side-firing KTP laser fiber was used at a setting of 30 Watts. In four patients the procedure was repeated once and in one patient the procedure was repeated 3 times due to the size of the bladder tumor that occupied more than 70% of bladder wall. Mean follow up was 8 months (range 3-24 months).
RESULTS: The operative times ranged from 20 to 145 minutes. 10 patients underwent general anesthesia and 2 received monitored sedation. Perioperative blood loss was minimal (less than 10 ml) in all patients. In the four patients with severe intractable bleeding durable hemostatsis was achieved with the use of KTP laser. In four patients that the laser was used for palliation, all reported decreased voiding symptoms and hematuria. In 6 patients with extensive low-grade superficial disease, complete tumor ablation was observed at follow-up cystoscopy.
No bladder perforation, ureteral obstruction or delayed bleeting occurred in this group of patients.
CONCLUSIONS: In cases that TURBT is not feasible, KTP laser is an effective and safe method to manage bladder tumors. Due to the excellent hemostatic properties of the KTP laser, the technique is particularly useful to manage extensive, low grade, superficial bladder cancer that is otherwise challenging to treat. Further studies are underway to evaluate the safety and efficacy of this technique.