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THE IMPORTANCE OF THE CHRONIC KIDNEY DISEASE GUIDELINES IN UROLOGY

Das et al. [9] resected 23 primary bladder cancers using HoLRBT, with a mean resection time of 18.6 min; all but one patient was treated as a day case, with no catheter. An Italian group successfully used HoLRBT in 50 patients (American Society of Anesthesiologists grade III or IV) under regional anaesthesia. Comparisons with a historical control group undergoing conventional TURBT were favourable: problematic bleeding was less common (6% HoLRBT group vs 14% conventional TURBT); catheters were less frequently needed (14% vs 100%); and discharge from hospital was earlier (within 48 h in 76% vs 6%, respectively) [10]. The findings of the Italian group were mirrored in a series from Bangladesh. 30 bladder tumours were resected with minimal bleeding, irrigation was unnecessary and all patients were discharged by 24 h with no catheter [11]. The costs of the laser might be offset by the less frequent use of catheters and irrigation and shorter hospital stays. The published studies on HoLRBT are not of a type that could demonstrate lower recurrence rates after HoLRBT than conventional TURBT. This question would need a randomized trial to provide the level of evidence required.