A prospective trial of flexible cystodiathermy for recurrent transitional cell carcinoma of the bladder

Purpose: The flexible cystoscope has a proved role in the followup of patie nts with transitional cell carcinoma of the bladder but the full extent of its therapeutic role has pet to be defined. We analyzed 171 flexible cystod iathermies to assess patient tolerance and treatment success. Potential cos t savings were also analyzed. Materials and Methods: All patients with single or multiple small papillary (Ta) recurrences at followup flexible cystoscopy were treated with flexibl e cystodiathermy. Plain lubricating gel was used and no other analgesia was prescribed. A visual analog pain scale was completed by the patient after the procedure and an observer rating of discomfort was recorded. Followup f or efficacy of treatment was performed. Results: A total of 103 patients mere treated with cystodiathermy during th e last 3 years. Median followup was 21 months (range 12 to 42). Of the pati ents 52 (50.5%) had no recurrence of transitional cell carcinoma after trea tment and 51 (49.5%) required treatment for recurrence. Only 13 patients (1 2.6%) had recurrences at or close to the original tumor site. Pain scales i ndicated that the procedure was well tolerated and all patients agreed to u ndergo it in the future if required. Estimated cost savings were approximat ely $66,500 per 100 patients. Conclusions: Flexible cystodiathermy is a well tolerated and efficacious tr eatment for recurrent small papillary (Ta) transitional cell carcinoma of t he bladder. Since transitional cell carcinoma of the bladder frequently occ urs in an elderly and often unfit population treatment that avoids general anesthetic offers considerable advantages.