Efficacy of office fulguration for recurrent low grade papillary bladder tumors less than 0.5 cm.

PURPOSE: Recurrent superficial papillary bladder tumors are most commonly treated with transurethral resection with the patient under anesthesia. We report our experience with office fulguration of small, recurrent, low grade papillary tumors using flexible cystodiathermy.
MATERIALS AND METHODS: We conducted a prospective single institution analysis of 267 consecutive patients with superficial bladder cancer undergoing routine bladder cancer surveillance between January 1998 and December 2001. Cytological and histological recurrences were recorded. Selection criteria for office fulguration were less than 5 low grade appearing papillary tumors, tumor size less than 0.5 cm, negative urine cytology and patient desire. All patients completed initial treatment (transurethral resection, partial cystectomy and/or intravesical therapy) and a minimum of 6 months on surveillance without recurrence (median 11.57 months).
RESULTS: Flexible cystodiathermy for small, low grade, recurrent papillary tumors was efficacious and well tolerated. Of the 123 patients 46% experienced 1 or more tumor recurrences (range 1 to 11) in a median followup of 2.6 years. Of these 123, 74 (60%) underwent office cystodiathermy. No difference was seen in disease specific survival (p = 0.1633) or disease progression (p = 0.860). When stratified by risk of recurrence 202 of 267 patients at high risk (76%) with low grade papillary recurrence had similar rates of progression to patients at low risk (p = 0.9025). Median time from diagnosis was 6.84 years, and time from last tumor was 20.4 months.
CONCLUSIONS: Office cystodiathermy of small, low grade papillary recurrence is safe and efficacious in properly selected patients. This change in practice can potentially improve patient quality of life and have a major economic impact on health care.