An analysis of the efficacy, safety, and cost-effectiveness of fulguration under local anesthesia for small-sized recurrent masses: a comparative analysis to transurethral resection of bladder tumors in a matched cohort.

BACKGROUND AND PURPOSE

To investigate the efficacy, safety, and cost-effectiveness of fulguration compared with traditional transurethral resection of a bladder tumor (TURB) among patients who had recurrent lesions after an initial TURB due to bladder cancer.

PATIENTS AND METHODS

For the period from March 2001 to January 2012, we reviewed the records of 42 patients who underwent a fulguration procedure for a recurrent Ta small bladder mass after excluding those with ≥1-cm sized masses at recurrence and those with masses at more than three sites. The included fulguration patients were matched with 42 TURB patients who presented with similar preoperative factors. The perioperative outcomes, including complications, recurrence-free survival rate, and total medical cost during each procedure, were compared.

RESULTS

The mean tumor size was similar between the two groups (0.54 cm in the fulguration group vs. 0.61 cm in the TURB group, p=0.161). During the follow-up periods, 12 patients (28.5%) in the fulguration group and 11 patients (26.2%) in the TURB group experienced tumor recurrence. The recurrence-free survival rate was similar for both groups (p=0.880). The mean total medical cost of fulguration was much cheaper compared with the TURB group (393.3 vs. 1164.6 US dollars, p<0.001).

CONCLUSIONS

Fulguration under local anesthesia for a small-sized recurrent mass is safe and efficacious in properly selected patients. In addition, it also significantly reduces the medical cost and avoids unnecessary anesthesia. Although the two treatments yielded similar oncological results, this finding should be validated in a large-scale, well-designed prospective study.