Introduction and Objectives
Outpatient TULA is an established technique for the treatment of urothelial tumours under local anaesthetic (1, 2), particularly in high ASA or anticoagulated patients. TULA is a time-efficient procedure, with improved haemostasis, avoidance of the obturator-nerve-reflex and reduced risk of bladder perforation. We report our initial experience in introducing the service in our department.
Methods
A service evaluation of the outpatient TULA flexible cystoscopy list was performed. Patients were referred with known bladder cancer or lesions for diagnosis and/or treatment. Higher grade tumours were treated only on the MDT recommendation, mostly treating G1/2 pTa TCC recurrences. Data was collected prospectively, including tumour characteristics, laser delivery and patient tolerance.
Results
There were 87 attendances to the TULA list between September 2016 and April 2017. TULA was performed in 58 cases: TCC (53/58), red patch (2/58), squamous metaplasia (1/58), radiation cystitis (1/58) and small cell cancer (1/58). Post-procedure one patient required hospital admission with bleeding and one patient complained of discomfort. In 6 cases, suspicious red patches were reviewed and 2 treated. Other attendances revealed: normal cystoscopy (24/29), stricture (1/29) or large/multiple tumours requiring TURBT (4/29). In total 14 patients were anticoagulated (5/14 warfarin).
Conclusion
Outpatient TULA of bladder lesions is an effective alternative to theatre-based procedures. It is well tolerated and can reduce departmental costs.
References
1. Syed HA, Talbot N, Abbas A, MacDonald D, Jones R, Marr TJ, et al. Flexible cystoscopy and Holmium:Yttrium aluminum garnet laser ablation for recurrent nonmuscle invasive bladder carcinoma under local anesthesia. Journal of endourology. 2013;27(7):886-91.
2. Bai Y, Liu L, Yuan H, Li J, Tang Y, Pu C, et al. Safety and efficacy of transurethral laser therapy for bladder cancer: a systematic review and meta-analysis. World journal of surgical oncology. 2014;12:301.