Clinical outcomes following transurethral laser ablation with topical versus general or spinal anesthesia for non–muscle-invasive bladder cancer: A Japanese single-center pilot study

OBJECTIVES: To compare transurethral laser ablation (TULA) outcomes for non-muscle invasive bladder cancer (NMIBC) performed under topical anesthesia versus general or spinal anesthesia in a Japanese cohort. METHODS: We retrospectively reviewed 28 patients who underwent 32 TULA sessions with a 980-nm diode laser from February 2024 to June 2025. Patients treated between February and October 2024 received TULA under general or spinal anesthesia (general or spinal anesthesia group, n = 14). Those treated between October 2024 and June 2025 underwent TULA with topical lidocaine lubrication (topical anesthesia group, n = 18). We compared demographic, perioperative, and short-term oncologic outcomes. Complications were graded according to Clavien-Dindo classification. RESULTS: Baseline characteristics were similar between groups. Operation time, treatment energy, and treatment duration were comparable. The topical anesthesia group experienced a significantly shorter median post-treatment hospital stay (1 [1-1] vs. 2 [2-2.75] days; p < 0.001) and catheterization duration (0 [0-0] vs. 1 [1-1] days; p < 0.001). Complications were mild (grade 1-2), affecting one general or spinal anesthesia group patient (7.1%) and three topical anesthesia group patients (16.7%). Under strict follow-up criteria (≥90 and ≥180 days), 3-month recurrence-free survival (RFS) was 100% (14/14) in both groups, and 6-month RFS was 92.3% (12/13) in the anesthesia group vs. 58.3% (7/12) in the topical anesthesia group. Kaplan-Meier analysis showed no statistically significant difference (p = 0.19). CONCLUSIONS: TULA under topical anesthesia for selected NMIBC patients was associated with shorter post-treatment hospital stays and a catheter-free recovery. Early oncologic outcomes, including short-term RFS, seem promising; however, these preliminary, pilot-scale findings warrant further validation in larger studies. TULA with topical anesthesia may provide perioperative advantages compared with procedures performed under general or spinal anesthesia, particularly in older patients or those with significant comorbidities.