Role of the Ho : Yag laser in the treatment of superficial bladder cancer in the elderly

摘要

Introduction. A considerable confusion exists in literature regarding the comparison between the employ of the laser and TUR for the treatment of Superficial Bladder Cancer (SBC) in terms of tumour recurrences (number,progression of stage and grade, place and time of them) and the economic costs. For this reason we have analysed the two procedures by a retrospective study to evaluate if the laser treatment had same advantages on the TUR which is still now considered the gold standard treatment. Materials and Methods. We examined two groups of 50 elderly patients with SBC, high incidence of comorbilities and anaesthesiological risk, who were treated by TUR or Ho. Yag laser. We considered for the resected tumours : stage, grade, size, multiplicity, history. Of the recurrences were analysed : number, place, time of appearance, grade and stage. Besides the time of surgical procedure, the complication rate, the catheterization time and the hospital stay were evaluated. Results. There was not a clear difference between laser and TUR about the recurrences for : number (30% and 36%), progression of stage and grade, place and time of appearance. An important result it was that at parity of surgical time in the laser group we had : 50% less of complications, 75% of the patients removed the catheter within 24hs with a postoperative hospital stay of 24-48 hs instead 4% and 40% in the TUR group. Conclusions. We conclude that the use of the Ho : Yag laser is actually the most advantageous method to treat the elderly with comorbilities and affected by little relapsing and low grade SBC for the low complication rate, reduction of the catheterization time, the hospital stay and the economic costs. These results point out that the Ho : Yag laser is an interesting technology to treat the elderly with comorbilities and this characteristic is still more important if we consider that for the ageing of the population we are moving towards an increase of the elderly urological pathology .