{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:15:53Z","timestamp":1779164153531,"version":"3.51.4"},"reference-count":20,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Non-muscle invasive bladder cancer (NMIBC) is characterized by high recurrence rates, requiring frequent diagnostic and therapeutic interventions. This study evaluates the feasibility, safety, oncological outcomes, and economic impact of implementing an in-office laser bladder tumor fulguration protocol. Methods: A descriptive, longitudinal study was conducted between 2020 and 2025 on 65 patients with recurrent NMIBC. Procedures were performed in an outpatient setting under local anesthesia using a flexible cystoscope and a Holmium:YAG (Ho:YAG) laser. The primary endpoint was recurrence-free survival. Secondary endpoints included complication rates (Clavien\u2013Dindo) and a cost-analysis comparison with conventional transurethral resection of the bladder (TURBT). Results: The mean age was 69.4 years, with 89.2% of patients classified as ASA \u2265 2. After a median follow-up of 20.3 months, the recurrence rate was 33.8%, with 0% progression. Most procedures (95.4%) had no complications; only 4.6% presented Clavien\u2013Dindo grade 1 events. Adjuvant mitomycin C was administered in 93.8% of cases. The cost analysis demonstrated substantial economic advantages, with costs reduced by 89.7% versus the 24 h admission model and 82.1% versus the day-surgery model according to regional health-system tariffs. Conclusions: In-office laser fulguration is a safe, effective, and economically sustainable alternative to traditional TURBT for selected low-risk recurrences. It optimizes hospital resources, minimizes anesthetic risk in comorbid patients, and maintains favorable oncological control.<\/jats:p>","DOI":"10.3390\/jcm15051939","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T08:51:33Z","timestamp":1772614293000},"page":"1939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["De-Intensification Strategies in Non-Muscle-Invasive Bladder Cancer: Outcomes and Cost Impact of In-Office Bladder Fulguration"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4183-2060","authenticated-orcid":false,"given":"Maria Teresa","family":"Melgarejo Segura","sequence":"first","affiliation":[{"name":"Department of Urology, San Cecilio Clinical University Hospital of Granada, Av. Dr. Jes\u00fas Candel Fabregas, s\/n, 18014 Granada, Spain"},{"name":"ibs.GRANADA Biosanitary Research Institute, Av. de Madrid, 15, Beiro, 18012 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Herraez Marcos","sequence":"additional","affiliation":[{"name":"Department of Urology, San Cecilio Clinical University Hospital of Granada, Av. Dr. Jes\u00fas Candel Fabregas, s\/n, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Carmen","family":"Cano Garcia","sequence":"additional","affiliation":[{"name":"Department of Urology, San Cecilio Clinical University Hospital of Granada, Av. Dr. Jes\u00fas Candel Fabregas, s\/n, 18014 Granada, Spain"},{"name":"ibs.GRANADA Biosanitary Research Institute, Av. de Madrid, 15, Beiro, 18012 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2320-5088","authenticated-orcid":false,"given":"Alberto","family":"Zambudio Munuera","sequence":"additional","affiliation":[{"name":"Department of Urology, San Cecilio Clinical University Hospital of Granada, Av. Dr. Jes\u00fas Candel Fabregas, s\/n, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Rodriguez Parras","sequence":"additional","affiliation":[{"name":"Department of Urology, San Cecilio Clinical University Hospital of Granada, Av. Dr. Jes\u00fas Candel Fabregas, s\/n, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3993-3911","authenticated-orcid":false,"given":"Miguel Angel","family":"Arrabal Polo","sequence":"additional","affiliation":[{"name":"Department of Urology, San Cecilio Clinical University Hospital of Granada, Av. Dr. Jes\u00fas Candel Fabregas, s\/n, 18014 Granada, Spain"},{"name":"ibs.GRANADA Biosanitary Research Institute, Av. de Madrid, 15, Beiro, 18012 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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