By T. N. Mills (auth.), T. A. McNicholas MB BS, FRCS (eds.)

The use oflasers in scientific perform is expanding swiftly, either within the definitive remedy of affliction and within the palliation of symp­ toms. as a result, this 6th contribution to the Bloomsbury sequence in medical technological know-how is especially well timed. It opens with an creation to the elemental physics of lasers after which makes a speciality of the present use of lasers in urological perform, and concludes via reflecting on their strength for the long run. Edited, and with numerous contributions through Tom McNicholas, the booklet additionally comprises contributions from a few employees on the nationwide scientific Laser Centre in college collage Hos­ pital. London. Given their ever widening program, there could be no doubt that lasers could be an issue the sequence will go back to back. to this point, the sequence has been taken with a variety of themes of primary significance in medical technological know-how. It has now won momentum and destiny titles proceed to mirror its vast sphere of curiosity. As sequence Editor, i'd welcome feedback from readers of themes and matters that may usefully be addressed within the series.

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However, it is necessary to check with the video manufacturer that a suitable filter has been fitted to the camera system to allow the surgeon to look down the beam splitter at the site oflaser action without danger. If a laser is being used with an endoscope sufficiently often, then it may be worth getting the manufacturer to insert a protective lens as part of the structure of the endoscope. This has the great advantage of avoiding the misting that often occurs between the add-on eyepiece and the original eyepiece of the instrument.

We feel strongly that a patient's initial tumour should be resected conventionally together with random biopsies and bimanual examination so that complete histological information is available at the start. Those patients with papillary low-grade superficial disease are then followed up on the outpatient laser list initially at 3 months and then at increasing intervals as long as they remain clear. Papillary recurrences are coagulated as they occur. Patients who develop sessile tumours, large numbers of recurrences or high-grade A Practical Guide to Laser Treatment 39 malignant cells on voided cytology revert to conventional treatment.

Conversely, high risk of recurrence was associated with multiple tumours, diameter over 3 cm, grade 2-3 tumours, TI stage, positive cytology and abnormal random biopsies. Cutler et al. (1982), reporting further NBCCG-A data, described 850 cases recruited between 1974 and 1976. Of these, 404 were presenting for the first time and 446 were known to have previously had bladder cancer. Their study showed an overall recurrence rate following conventional treatment for Ta tumours of 31% at 12 months, 45% at 24 months and 54% at 36 months, compared with 39%, 52% and 56% respectively for TI tumours.

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