A national snapshot survey of transurethral laser ablation for non-muscle-invasive bladder cancer

Non-muscle invasive bladder cancer (NMIBC) is traditionally managed with transurethral resection of bladder tumour (TURBT) and intravesical therapy. Although effective, TURBT carries morbidity, particularly in frail or comorbid patients. Outpatient transurethral laser ablation (TULA) is an emerging alternative with fewer complications. However, national data on patient selection and practice patterns are limited. This survey provides a contemporary overview of TULA use in the United Kingdom. A structured questionnaire was distributed to UK urologists, assessing current TULA practice, selection criteria, and barriers to service delivery. Responses were received from 105 urologists. Of these, 60 (57%) reported performing TULA, averaging 348 procedures annually. Indications included low-grade, small (<1 cm) superficial recurrences, and primary treatment in patients unsuitable for TURBT due to comorbidities. Additional considerations were anticoagulated patients and challenging lesion sites, such as the bladder dome. Reported limitations included technical challenges with lesion visibility during flexible cystoscopy, difficulties at the bladder neck, and service constraints related to funding and laser equipment availability. TULA is a promising treatment for carefully selected NMIBC cases, particularly in frail populations. Standardised selection criteria, prospective monitoring of outcomes, and establishment of a national registry are required to guide safe practice, inform clinical guidelines, and support equitable service provision. Level 4 cohort study