200 Outpatient Transurethral Laser Ablation (Tula) of Bladder Tumours: Our Initial Experience

Background Transurethral laser ablation (TULA) is a safe and cost-effective treatment for non-muscle invasive bladder cancer. We report our experience of establishing an outpatient TULA service at a DGH. Method Retrospective review of attendances to the TULA clinic from May 2022 to May 2023. Data were analysed using EZR. Results Ninety-seven TULA procedures were performed on 87 patients (45-95 years; median age 79 years; 70.1 % male; median ASA grade 2). Fifty-three lesions were unifocal and 44 were multifocal. Ablations were performed in 79 cases (81.4%), enucleations in 15 cases (15.5 %) and 3 patients (3.1%) underwent both. Of the 66% of patients with recurrent cancer, 62.5% had previously been diagnosed with high-grade cancers. Biopsies were performed in 66% of cases, with muscle present in 9.4% of specimens. Transitional cell carcinoma was confirmed in 21 of 64 biopsies with the commonest stage being G2pTa (45.5%). Two patients were re-admitted within 30 days due to haematuria and 3 patients developed a urinary tract infection within 2 weeks. Eleven attendances were not amenable to TULA either due to tumour size (n=10) or position (n=1). The median pain score reported by 45 patients was 1 (IQR 3). Of the 38 patients who had previously undergone a GA resection, 95% preferred TULA due to reduced pain (52.6%), shorter procedure time (84.2%) and avoidance of inpatient stay (57.9%). Conclusions TULA provides a safe alternative for treating superficial bladder cancer with high patient satisfaction rates, thereby reducing demand on inpatient and operative services. Future work involves assessing recurrence rates after TULA.