TRANSURETHRAL ND: YAG LASER SURGERY FOR BLADDER TUMORS

Recently, medical applications of laser beams have been discussed in numerous reports. Since a flexible delivery system was developed, it has been possible to transmit Nd: YAG laser light through a quartz fiber, making it feasible to perform transurethral laser surgery. Herein, we report the results of the Nd: YAG laser on bladder tumors through endoscopy. Thirty nine patients with 50 bladder tumors were treated by transurethral Nd: YAG laser irradiation. The equipment employed for laser surgery was a Medilas YAG and Wolf Laser Cystoscope. The transurethral laser operation was performed while irrigating the bladder with a 10% urigal solution. Lumbar anesthesia was used in 31 cases and local anesthesia in 8. A five-second beam of 50-watt electric power was chosen as one unit of irradiation, and 5 to 50 units of irradiation were utilized for one operation. Twenty nine tumors were completely resected with laser irradiation alone. In the other 21 tumors, electroresection or partial cystectomy was undertaken after laser therapy. The results of the laser operation were analyzed according to the tumor location, characteristics, size and histopathology. From our present clinical experiences, we would like to make the following remarkes. (1) The indication for laser surgery is small tumor less than 1cm in diameter. (2) Transurethral Nd: YAG laser surgery could be performed local anesthesia. Accordingly, it is indicated even for patients with severe complications. (3) Only a minimal or no bleeding occurred during the operation. Even bleeding occurred, hemostasis was easily managed by additional irradiation. (4) Complications are rare. We have never experienced perforation of either the bladder or the intestine. (5) Obturator nerve reflex does not occur with laser irradiation. (6) In nine of the 39 cases tumor recurrence appeared at between 2 and 12 months. Laser surgery through endoscopy thus represents a promising approach for the treatment of bladder tumors and could be applied to patients with severe complications.