title: An analysis of the efficacy, safety, and cost-effectiveness of fulguration under local anesthesia for small-sized recurrent masses: a comparative analysis to transurethral resection of bladder tumors in a matched cohort.
abstract: OBJECTIVE
  To investigate the efficacy, safety, and cost-effectiveness of fulguration compared with traditional transurethral resection of a bladder tumor (TURB) among patients who had recurrent lesions after an initial TURB due to bladder cancer.
  
  
  METHODS
  For the period from March 2001 to January 2012, we reviewed the records of 42 patients who underwent a fulguration procedure for a recurrent Ta small bladder mass after excluding those with ≥1-cm sized masses at recurrence and those with masses at more than three sites. The included fulguration patients were matched with 42 TURB patients who presented with similar preoperative factors. The perioperative outcomes, including complications, recurrence-free survival rate, and total medical cost during each procedure, were compared.
  
  
  RESULTS
  The mean tumor size was similar between the two groups (0.54 cm in the fulguration group vs. 0.61 cm in the TURB group, p=0.161). During the follow-up periods, 12 patients (28.5%) in the fulguration group and 11 patients (26.2%) in the TURB group experienced tumor recurrence. The recurrence-free survival rate was similar for both groups (p=0.880). The mean total medical cost of fulguration was much cheaper compared with the TURB group (393.3 vs. 1164.6 US dollars, p<0.001).
  
  
  CONCLUSIONS
  Fulguration under local anesthesia for a small-sized recurrent mass is safe and efficacious in properly selected patients. In addition, it also significantly reduces the medical cost and avoids unnecessary anesthesia. Although the two treatments yielded similar oncological results, this finding should be validated in a large-scale, well-designed prospective study.
authors: 1 Department of Urology, CHA Bundang Medical Center, CHA University , Seongnam, Korea.
authors: Dong Soo
authors: DS
authors: Park
authors: Jin Ho
authors: JH
authors: Hwang
authors: In Hyuck
authors: IH
authors: Gong
authors: Don Kyung
authors: DK
authors: Choi
authors: Moon Hyung
authors: MH
authors: Kang
authors: Jong Jin
authors: JJ
authors: Oh
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D004564:Electrocoagulation / Q000009:adverse effects / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*