302 bladder tumors to a size of a thumb tip were treated with a Nd:YAG laser. 196 larger bladder tumors were removed by transurethral resection combined with laser irradiation 1 week later. In all cases tumors were classified as pTA to pT(3a), N(0), M(0) tumors. 8 weeks after treatment we found local recurrences in 9% using the rigid laser endoscopes. On the contrary, the local recurrence was 2.1% using laser endoscope with modified Albarran insert. In proven cases the Nd:YAG laser application is an effective and careful procedure to destroy bladder tumors.