Hermann Gregers Gautier, Mogensen Karin, Rosthøj Susanne
a Department of Urology , Herlev & Gentofte Hospitals, Copenhagen University , Hellerup , Denmark.
b Section of Biostatistics Faculty of Health and Medical Sciences , Institute of Public Health, University of Copenhagen , Copenhagen , Denmark.
Scand J Urol. 2018 Jun;52(3):194-198. doi: 10.1080/21681805.2018.1450782. Epub 2018 Apr 1.
This study aimed to validate a new method for outpatient diode laser ablation of bladder tumors without sedation or pain control.
Twenty-one patients with stage Ta low-grade intermediate-risk bladder tumors underwent photodynamic-guided laser ablation of their bladder tumors and 1 month later follow-up cystoscopy with photodynamic and IMAGE1 S™-guided biopsies. Pain was measured using a visual analog scale (range 0-10). Symptoms and worries about the future disease course were calculated using the Quality of Life Questionnaire for Non-Muscle-Invasive Bladder Cancer (range 0-100, high scores indicating worse symptoms or worry). Costs of outpatient laser treatment versus inpatient conventional bladder tumor resection in the operating theatre were compared.
Patients had a median of three tumors (range 1-12). The median pain score was 1.0 (range 0-7) during laser ablation. Median quality of life scores were 24 (range 0-67) for symptoms and 42 (0-100) for worry. Two patients had minor hematuria and five had dysuria after laser therapy. Five patients (24%) had new Ta low-grade recurrence within 13 months that was biopsied and laser treated. No tumors progressed. Four patients had tumors identified using photodynamic diagnosis, and two had flat low-grade dysplasia identified using IMAGE1 S SPECTRA A and B and photodynamic diagnosis, none of which was seen using white-light cystoscopy. Outpatient laser treatment could save about €140,000 per million inhabitants versus inpatient bladder tumor surgery.
Fluorescence-guided diode lasers provide efficient and almost pain-free treatment of low-grade urothelial cancer in conscious patients and could reduce healthcare costs.
本研究旨在验证一种无需镇静或疼痛控制的门诊二极管激光消融膀胱肿瘤的新方法。
21例Ta期低级别中危膀胱肿瘤患者接受了光动力引导下的膀胱肿瘤激光消融治疗，1个月后进行了光动力和IMAGE1 S™引导活检的随访膀胱镜检查。使用视觉模拟量表（范围0-10）测量疼痛程度。使用非肌层浸润性膀胱癌生活质量问卷（范围0-100，高分表示症状更严重或担忧程度更高）计算症状和对未来疾病进程的担忧程度。比较了门诊激光治疗与手术室住院常规膀胱肿瘤切除术的费用。
患者的肿瘤中位数为3个（范围1-12个）。激光消融期间的疼痛中位数评分为1.0（范围0-7）。症状的生活质量中位数评分为24（范围0-67），担忧程度的中位数评分为42（0-100）。两名患者激光治疗后出现轻度血尿，五名患者出现排尿困难。五名患者（24%）在13个月内出现新的Ta期低级别复发，接受了活检和激光治疗。无肿瘤进展。四名患者通过光动力诊断发现肿瘤，两名患者通过IMAGE1 S SPECTRA A和B及光动力诊断发现扁平低级别发育异常，白光膀胱镜检查均未发现。与住院膀胱肿瘤手术相比，门诊激光治疗每百万居民可节省约140,000欧元。
荧光引导二极管激光可为清醒患者的低级别尿路上皮癌提供高效且几乎无痛的治疗，并可降低医疗成本。
