There were 32 high risk patients with stages T2 to T4 bladder cancer treated with neodymium:YAG laser irradiation to the tumor base after cautery resection between July 1981 and October 1986. All 12 patients with stage T2 disease followed for 6 to 78 months had no recurrence locally although 4 had stage T1 recurrences elsewhere in the bladder. Of 14 stage T3 cancer patients 8 demonstrated tumor persistence locally but 3 were well 4 to 24 months later without local recurrence (all stage T3a) and 3 were alive 14 to 24 months later with stage T1 recurrences. Of 6 stage T4 cancer patients 4 obtained reasonable hemorrhagic control with laser irradiation used for palliation purposes. A 90-year-old man with stage T3b disease died 5 days postoperatively of a myocardial infarct but no bladder or bowel perforation was documented. We believe that neodymium:YAG laser irradiation is a safe alternative for the treatment of bladder cancer in selected patients.