Delayed Surgery for localised prostate cancer: A systematic review for the COVID-19 Pandemic

Introduction: Traditionally the management of nonmuscle invasive bladder cancer (NMIBC) involves rigid cystoscopy and bladder biopsies/tumour resection under general/regional anaesthesia. The COVID-19 pandemic forced hospitals to reduce operating lists and increase bed availability. An outpatient TULA service was recently started at our trust. TULA is performed via a flexible cystoscopy without the need for anaesthetic. Anticoagulation/ anti-platelets can continue and antibiotics are not routinely administered. We present a case series of our first 4 months data. Patients and Methods: All TULA cases (n=39) performed between Aug-Dec 2020 were included. Data was gathered prospectively including: patient demographics, co-morbidities, medications, initial cancer diagnosis grading/ staging and number of subsequent recurrences, histopathological data, post-procedural complications and patient procedural satisfaction. Results: Median age was 82 years (range 34-96) and median Charleston score was 7 (range 2-12). Previous bladder cancer diagnosis was present for 85% with the most common initial stage G2pTa (n=11). Median number of recurrences was 1 (range 1-5). Median patient perceived pain score was 3 (range 1-7) with 100% of patients preferring TULA over TURBT. Reasons included reduced procedural time (n=18) and enhanced recovery (n=15). One grade-1 Clavien-Dindo classification complication was noted. Conclusion: TULA is safe for all low risk NMIBC, particularly for frail patients. It is well tolerated and facilitates improved patient experience. It also alleviates demand on theatre capacity and inpatient beds, allowing these patients to continue to be treated despite the pressures exerted on the NHS during the pandemic. Further audit of clinical outcomes should continue as recommended by NICE.