Laser treatment of transitional cell cancer of the bladder and upper urinary tract.

Nd:YAG laser therapy now has a well-defined role in the treatment of superficial bladder cancer, that is, it is indicated only when one needs to destroy present tumors. Available results suggest that tumor recurrence is reduced, but definitive evidence of this is lacking. The laser's main advantage is that the procedure is carried out without anesthesia on an outpatient basis, because it is a noncontact technique that is associated with minimal morbidity and reduced pain and bleeding. Nd:YAG laser use in invasive bladder cancer would appear to be adequate for palliation only. For this indication, its benefits must be compared with conventional palliative TUR and/or radiation therapy. Laser therapy of tumors in the upper urinary tract is still in its infancy. Urothelial cancer is a multifocal disease, and the critical caveat, as in the case of bladder cancer, is tumor recurrence. Routine access to the upper tract and accurate assessment of the grade and stage of the tumor and the multifocality of the disease are of paramount importance and are not yet perfected. Photodynamic therapy is an intriguing modality. It has much potential for future development, but at present, because of its reduced ability to control superficial cancer, particularly when compared with other available forms of treatment such as intravesical BCG, and because of its significant associated morbidity, its use remains investigational.