Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Kings College London, London, UK.
Eur Urol Focus. 2022 Jan;8(1):141-151. doi: 10.1016/j.euf.2021.01.019. Epub 2021 Feb 16.
Management of non-muscle-invasive bladder cancer (NMIBC) is costly and associated with negative health-related quality-of-life effects, in part because of the frequent need for repeated transurethral resections under general/regional anaesthesia. Outpatient-based diathermy or laser ablation is another option, but evidence for its efficacy is mixed and its use is controversial.
To systematically review evidence regarding the efficacy and safety of outpatient diathermy and laser ablation for the treatment of recurrent NMIBC.
The EMBASE, MEDLINE/PubMed, and Cochrane Library were searched from inception to June 26, 2020. All studies evaluating the use of diathermy or laser ablation for bladder tumours (new or recurrent) in an outpatient setting under local anaesthetic were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools.
The search yielded 1328 studies. After excluding duplicates, 1319 titles and abstracts were screened and 17 studies (1584 patients) were eligible for inclusion in the final review. The majority of patients had small, low-grade tumours, but there was heterogeneity in the inclusion criteria. Overall, laser ablation and diathermy resulted in mean recurrence rates of 47% and 32% at follow-up of 22-38 mo, respectively, with a mean progression rate of 3-12% (low certainty of evidence). Both procedures were well tolerated, with low pain scores and low periprocedural complication rates (moderate certainty of evidence).
Outpatient diathermy and laser ablation have good short-term efficacy in patients with low-grade NMIBC and reduce the need for intervention under general/regional anaesthesia. The procedures are well tolerated with low complication rates. The overall certainty of evidence is low, with heterogeneity between studies and methodological limitations. However, we have highlighted the need for randomised trials with long-term follow-up using standardised risk classification and outcome measures. Despite these limitations, the findings will aid in patient counselling regarding this less invasive treatment option that avoids the morbidity of transurethral resection.
Outpatient diathermy and laser ablation have good success rates in treating recurrent low-grade bladder tumours in the short term, avoiding the need for more invasive procedures under general/regional anaesthesia, with low rates of side effects. Further studies are needed to determine whether these treatments remain safe and effective in the long term.
非肌肉浸润性膀胱癌（NMIBC）的治疗费用昂贵，且会对患者健康相关生活质量产生负面影响，部分原因是经常需要在全身/区域麻醉下重复经尿道切除术。门诊电切或激光消融术是另一种选择，但疗效证据不一，其应用存在争议。
系统评价门诊电切和激光消融治疗复发性 NMIBC 的疗效和安全性。
从建库至 2020 年 6 月 26 日，检索 EMBASE、MEDLINE/PubMed 和 Cochrane Library。纳入所有评估局部麻醉下门诊使用电切或激光消融治疗膀胱肿瘤（新发或复发）的研究。两名评审员独立筛选所有文章，检索已获取文章的参考文献，并进行数据提取。使用 GRADE 和 ROBINS-I 工具评估证据质量和偏倚风险。
检索得到 1328 项研究。剔除重复后，筛选 1319 篇标题和摘要，17 项研究（1584 例患者）符合最终综述纳入标准。大多数患者肿瘤较小、分级较低，但纳入标准存在异质性。总体而言，激光消融和电切的随访 22-38 个月后复发率分别为 47%和 32%，进展率分别为 3%-12%（证据确定性低）。两种方法均耐受良好，疼痛评分低，围手术期并发症发生率低（证据确定性中等）。
门诊电切和激光消融治疗低级别 NMIBC 患者短期疗效较好，减少了全身/区域麻醉下干预的需求。该方法耐受性好，并发症发生率低。证据整体确定性较低，研究间存在异质性和方法学局限性。但是，我们强调需要使用标准化风险分类和结局指标进行长期随访的随机试验。尽管存在这些局限性，本研究结果将有助于患者就这种避免经尿道切除术带来发病率的更微创治疗选择进行咨询。
门诊电切和激光消融治疗复发性低级别膀胱肿瘤短期内成功率较高，避免了全身/区域麻醉下更具侵袭性的手术，且副作用发生率低。需要进一步研究来确定这些治疗方法在长期内是否仍然安全有效。
