ABSTRACT

About 80% of newly diagnosed patients with bladder cancer have non-muscle invasive bladder tumors, of which 50% will either be low grade papillary tumors (Ta, papilloma or papillary urothelial neoplasms of low malignant potential). Transurethral resection has become the gold standard therapy for non-muscle invasive bladder tumors. But the majority of these tumors recur within 5 years. Most of the recurrent tumors are small and low grade tumors without invasion. The treatment of recurrent papillary tumors can be done under general or spinal anesthesia. But most of these patients are elderly with additional medical problems. To avoid the complications related to these anesthesia or medical problems, these patients can be treated with fulgurazation or laser vaporization as an outpatient procedure.

Small, recurrent, low grade appearing bladder tumors are slow growing and pose minimal risk. Laser vaporization or cystodiatermy of small, low grade papillary recurrences is safe and efficacious in properly selected patients. This change in practice can potentially improve patient quality of life.However, it should not replace transurethral resection as primary treatment for the initial tumor or for recurrence suspected on gross inspection to represent a change in tumor stage or grade.