New interventional procedures guidance from NICE states that current evidence on transurethral laser ablation for recurrent non-muscle-invasive bladder cancer (NMIBC) shows no major safety concerns. However, it adds, available evidence on its efficacy is limited in quality and quantity.
Therefore, it says, the procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wishing to use the procedure for recurrent NMIBC must inform the clinical governance leads in their NHS trusts.
Furthermore, clinicians must ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy, and provide them with clear written information to support shared decision making.
Clinical outcomes of all patients having transurethral laser ablation for recurrent NMIBC must be audited and reviewed. NICE has identified relevant audit criteria and has developed an audit tool, which is available for use at local discretion. Patient selection should be done by a specialist bladder cancer multidisciplinary team.
The guidance follows a rapid review of the published literature on the procedure, comprising a comprehensive literature search and detailed review of evidence from six case series, two non-randomised comparative studies, and one case report.