To investigate the feasibility of thulium laser bladder tumor resection using cystoscopy under local anesthesia (urethral mucosal anesthesia) or no anesthesia in elderly patients with high risk of anesthesia, and to find an appropriate and effective treatment method for these special patients.

Between June 2020 and January 2022, 12 elderly patients in the Second Hospital of Tianjin Medical University with bladder cancer accompanied with severe comorbidity underwent thulium laser transurethral resection of bladder tumor using a flexible cystoscope under local anaesthesia. Preoperative assessment of intraoperative and post-operative risk using anesthesia classification standard, Essen stroke risk scale, exercise tolerance, revised cardiac risk index and cardiac complication rate, and crude prediction of post-operative recovery and surgical value using Karnofsky performance functional status scale, age-adjusted charlson comorbidity index score and the frailty screening scale, the status of patients were assessed immediately after surgery. Patients were assessed for tolerance by the numerical rating scale immediately intraoperatively, while the data of the duration of urinary catheter retention, postoperative hospital stay and complications were collected postoperatively. The patients were followed to January 2023 or disease recurrence.

All patients had no intraoperative obturator nerve reflexes or bladder perforationm, no persistent bladder bleeding or bladder tamponade postoperatively. Immediate pain scores ranged from 0-7 with a mdian of 2. All patients tolerated the procedure with less pain, the median duration of postoperative urethral catheterization was 2 days. The median postoperative hospital stay was 2 days. Twelve patients were followed up regularly with a follow-up period of 3-19 months; one patient was lost, one patient recurred 5 months after surgery and one patient recurred 13 months after surgery.

It's a relatively safe and effective way of treating high-risk patients with bladder cancer who are at high risk of anaesthesia by ThuLRBT under local anaesthetic using a flexible cystoscope, with few complications, good patient tolerance and satisfactory recent outcomes.