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Outpatient Photodynamic Diagnosis-guided Laser Destruction of Bladder Tumors Is as Good as Conventional Inpatient Photodynamic Diagnosis-guided Transurethral Tumor Resection in Patients with Recurrent Intermediate-risk Low-grade Ta Bladder Tumors. A Prospective Randomized Noninferiority Clinical Trial. Eur Urol 2023; 83:125-130. [PMID: 36058804 DOI: 10.1016/j.eururo.2022.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Transurethral resection of recurrent low-grade intermediate-risk Ta bladder tumor (BT) in general anesthesia (GA) is burdensome to patients and health care system. Laser technologies enable treatment in office-based settings, reducing morbidity and costs. OBJECTIVE To compare 4-mo recurrence-free survival after outpatient department (OPD) diode laser coagulation of BT in local anesthesia and gold standard transurethral resection of BT (TUR-BT) in GA in intermediate-risk Ta low-grade BT, and to evaluate treatment-related morbidity. DESIGN, SETTING, AND PARTICIPANTS A prospective randomized noninferiority trial with 4-mo follow-up, in the hospital setting, was conducted in Capital Region of Denmark from 2016 to 2020. Participants were patients with histologically verified Ta low-grade BT recurrence. A total of 206 patients were randomized; 176 finished treatment and follow-up as per protocol. INTERVENTION Laser photocoagulation of bladder tumor (PC-BT) in OPD using a 980 nm diode laser compared with gold standard TUR-BT in GA, both performed with photodynamic diagnosis (PDD) guidance. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Four-month recurrence-free survival was assessed; predefined inferiority criterion was set at 15%. The secondary outcomes were pain during PC-BT, postoperative morbidity, postoperative complications, and patient's preference. RESULTS AND LIMITATIONS Four-month recurrence-free survival was 8% higher after PC-BT (95% confidence interval [CI]: -8% to 24%). The predefined noninferiority criterion was met. Pain score (1-10) during PC-BT was 2.4 (interquartile range 0.8-3.3). Postoperative lower urinary tract symptom score (0-100) was 13.9 points higher (95% CI: 6.9-21.0, p < 0.001) in the group with transurethral resection of the bladder. The frequency of minor complications was 8.1% higher after TUR-BT (95% CI: 1.0-14.6%, p = 0.026). Of the patients, 98% (95% CI: 92-100%) preferred PC-BT. CONCLUSIONS PDD-guided PC-BT in OPD is as good as TUR-BT in GA to remove recurrent low-grade Ta BT. Postoperative quality of life is better after PC-BT and the frequency of minor complications was lower. PATIENT SUMMARY This study evaluates the efficacy of outpatient laser removal of low-grade noninvasive bladder tumor. Outpatient tumor removal with laser was as good as transurethral resection in general anesthesia and less burdensome to patients.
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Andersson M, Berger M, Zieger K, Malmström PU, Bläckberg M. The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem. Scand J Urol 2021; 55:263-267. [PMID: 34037496 DOI: 10.1080/21681805.2021.1928746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate whether outpatient blue-light flexible cystoscopy could solve the diagnostic challenge of positive or suspicious urine cytology findings despite normal white-light flexible cystoscopy results and normal findings on computerized tomography urography, in patients investigated for urothelial cancer. MATERIAL AND METHODS In a multicentre study, a total of 70 examinations were performed with the use of blue-light flexible cystoscopy (photodynamic diagnosis) after intravesical instillation of the fluorescence agent hexaminolevulinate. The examination started with a conventional white-light flexible cystoscopy and then the settings were switched to use blue light. Suspicious lesions were biopsied. Afterwards, the patients were interviewed regarding their experience of the examinations. RESULTS Bladder cancer was diagnosed in 29 out of 70 (41%) cases, among them 14/29 (48%) had malignant lesions seen only in blue light. The majority had carcinoma in situ (21/29). Normal findings were seen in 41 cases that underwent BLFC. During the further course, malignancy of the bladder was detected in six cases (9%) and malignancy of the upper urinary tract was detected in one case (1%). The majority of patients (93%) preferred the blue-light flexible cystoscopy performed at the outpatient clinic instead of the transurethral resection under general anaesthesia. CONCLUSION Blue-light flexible cystoscopy at the outpatient clinic may be a useful tool to solve unclear cases of a malignant or suspicious urinary cytology suggestive of bladder cancer. The procedure was well tolerated by the patients.
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Affiliation(s)
- Marie Andersson
- Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Marthe Berger
- Department of Urology, Lillebelt Hospital, Vejle, Denmark
| | - Karsten Zieger
- Department of Urology, Lillebelt Hospital, Vejle, Denmark
| | - Per-Uno Malmström
- Department of Urology, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Bläckberg
- Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
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Biopsy at flexible cystoscopy: is it worthwhile? Ir J Med Sci 2020; 190:437-439. [PMID: 32613562 DOI: 10.1007/s11845-020-02284-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Flexible cystoscopy is the gold standard for diagnosis and surveillance of bladder carcinoma. Most flexible cystoscopes feature a working channel allowing for bladder biopsy and diathermy if a suspicious lesion is observed. However, the working channel permits only small instruments which limit the volume of material retrieved for histological analysis. There are no published standards for quality control of biopsy specimens taken at flexible cystoscopy. We reviewed the diagnostic yield of biopsies taken at flexible cystoscopy at our institution. METHODS Theatre log books were retrospectively examined to identify cases of flexible cystoscopy where bladder biopsy was performed. Histopathology reports were reviewed. All biopsies were taken using single-use biopsy forceps, diameter 1.8 mm, open cup width 4.5 mm. RESULTS From January 2014 to December 2017, a total of 143 biopsies were performed. All biopsies were taken for suspicious lesions where the differential diagnosis included malignancy. Of the 143 samples taken, 27 biopsies showed evidence of malignancy, and 9 cases were high-grade urothelial cancer. A total of 16 samples were inadequate for any histological diagnosis. All remaining samples excluded malignancy within the sample provided. A histopathological diagnosis was provided for almost 89% of cases. CONCLUSION Approximately 18% of biopsies detected malignancy. While only small volumes of tissue are collected at flexible cystoscopy, these can help to distinguish malignancy from benign pathology. Our institution reports a non-diagnostic rate of approximately 11%, and in these cases, when there is still a suspicion of malignancy, a rigid cystoscopy and biopsy should be performed.
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Erikson MS, Petersen AC, Andersen KK, Jacobsen FK, Mogensen K, Hermann GG. Do repeated transurethral procedures under general anesthesia influence mortality in patients with non-invasive urothelial bladder cancer? A Danish national cohort study. Scand J Urol 2020; 54:281-289. [PMID: 32584153 DOI: 10.1080/21681805.2020.1782978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the effect of repeated transurethral procedures under general anesthesia on overall mortality in patients with non-invasive bladder cancer.Materials and methods: All Danish residents with non-invasive papillary urothelial carcinoma or primary urothelial carcinoma in situ diagnosed between 1 January 2000 and 1 January 2011 were included and followed until death or 31 March 2017. All transurethral procedures under general anesthesia, intravesical instillation therapy, recurrences and progression to invasive disease or cystectomy were recorded during follow-up. Associations between treatments and overall mortality were evaluated using multivariable regression analysis adjusted for age, gender, comorbidities and socioeconomic status. The effect of disease progression on mortality was removed by censoring patients at the time of progression or cystectomy.Results: Risk of death increased with the number of transurethral procedures under general anesthesia for Ta low- and high-grade tumors compared to patients who had only one procedure; after eight or more procedures the risk of death increased by 28% and 83%, respectively. There was no similar relationship for carcinomas in situ. In total, 36-52% of procedures under general anesthesia did not identify urothelial neoplasia.Conclusions: Repeated transurethral procedures under general anesthesia appear to be associated with increased risk of death in patients with primary non-invasive papillary urothelial carcinoma. Furthermore, a substantial number of procedures were without findings of neoplasia, indicating that too many patients are admitted for transurethral procedures under GA. Attempts should be taken to reduce unnecessary transurethral procedures under GA, e.g. by improved outpatient diagnosis of urothelial neoplasia.
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Affiliation(s)
- Marie Schmidt Erikson
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Klaus Kaae Andersen
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Frederik Krogsdal Jacobsen
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Karin Mogensen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Gregers Gautier Hermann
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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DaBlaCa-11: Photodynamic Diagnosis in Flexible Cystoscopy-A Randomized Study With Focus on Recurrence. Urology 2019; 137:91-96. [PMID: 31843623 DOI: 10.1016/j.urology.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/21/2019] [Accepted: 12/03/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine whether photodynamic diagnosis (PDD) in addition to flexible cystoscopy in the outpatient clinic can reduce risk of tumor recurrence in patients with previous nonmuscle invasive bladder cancer. PDD is an optical technique that enhances the visibility of pathologic tissue and helps guidance tumor resection. METHODS From February 2016 to December 2017, 699 patients from 3 urologic departments in Denmark were enrolled in a randomized controlled trial. Four months after transurethral resection of bladder tumor patients were randomized 1:1 to either an intervention group (hexaminolevulinate was instilled in the bladder before flexible cystoscopy with PDD video cystoscope) or a control group (white light flexible cystoscope), only. Primary endpoint was tumor recurrence within 8 months from the randomization. Secondary outcomes were numbers of procedures in general anesthesia, time to the first recurrence, differences in tumor size, risk of tumor progression, and identification of carcinoma in situ. RESULTS A total of 351 patients were allocated to the intervention group (flexible PDD), and 348 to the control group (flexible white light). Throughout the following 8 months after randomization, only 117 patients in the intervention group had at least 1 tumor recurrence compared to 143 patients in the control group (P = .049). Odds ratio of 0.67 (P = .02, 95% CI: 0.48-0.95) correlates with a tumor reduction of 33% in favor of the intervention group. CONCLUSION Use of PDD in a routine surveillance cystoscopy first time after transurethral resection of bladder tumor for nonmuscle invasive bladder cancer reduces subsequent risk of tumor recurrence compared to WL cystoscopy alone.
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Zare R, Grabe M, Hermann GG, Malmström PU. Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration. Res Rep Urol 2018; 10:151-157. [PMID: 30349812 PMCID: PMC6188219 DOI: 10.2147/rru.s141314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this prospective cohort study was to determine the feasibility of incorporating blue light flexible cystoscopy (BLFC) and biopsy/fulguration into routine outpatient follow-up of non-muscle invasive bladder cancer patients. METHODS The study included patients with non-muscle-invasive bladder cancer (NMIBC) who were scheduled for routine follow-up. Hexaminolevulinate was instilled in the outpatient department, and the bladder was examined under white light and then with BLFC. Biopsies were taken from all suspicious lesions. Small tumors and suspicious lesions were fulgurated on site; patients with larger lesions were referred to the operating room for resection. RESULTS The study included 69 patients, with a mean age of 70 years (range 33-89 years) and a mean duration since NMIBC diagnosis of 8 years. Most patients had high-grade cancer at initial diagnosis (52/69) and were at high risk of recurrence (48/69). Two patients per hour could be assessed using outpatient BLFC. Preparation and instillation of hexaminolevulinate took less than 10 minutes per patient, and patients had an additional waiting time of 45-60 minutes following instillation, while the hexaminolevulinate solution was retained in the bladder before examination. Eleven patients had histologically confirmed tumors that were identified using both white light flexible cystoscopy and BLFC. An additional three patients had tumors that were identified by BLFC only: two with Ta tumors and one with carcinoma in situ. Of the 14 patients with confirmed tumors, 11 could be managed on site with fulguration, whereas three were referred to the operating room. No adverse events attributable to BLFC were reported. CONCLUSION Routine outpatient management of patients with NMIBC using BLFC and on-site biopsy/fulguration is feasible, despite the additional time required for hexaminolevulinate instillation, and appears to allow early detection of recurrent lesions, which can be fulgurated without the need for hospitalization.
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Affiliation(s)
- Reza Zare
- Department of Urology, Vestre Viken HF Bærum Hospital, Oslo, Norway,
| | - Magnus Grabe
- Department of Urology, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Gregers G Hermann
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen University, Denmark
| | - Per-Uno Malmström
- Department of Urology, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Drejer D, Jensen JB, Bryan RT. Red patches during bladder cancer surveillance: to biopsy or not to biopsy? Transl Androl Urol 2018; 7:280-282. [PMID: 29733089 PMCID: PMC5911540 DOI: 10.21037/tau.2018.03.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ditte Drejer
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Urology, Regional Hospital of West Jutland, Holstebro, Denmark.,Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Urology, Regional Hospital of West Jutland, Holstebro, Denmark
| | - Richard T Bryan
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
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Hermann GG, Mogensen K, Rosthøj S. Outpatient diode laser treatment of intermediate-risk non-invasive bladder tumors without sedation: efficacy, safety and economic analysis. Scand J Urol 2018; 52:194-198. [DOI: 10.1080/21681805.2018.1450782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Gregers Gautier Hermann
- Department of Urology, Herlev & Gentofte Hospitals, Copenhagen University, Hellerup, Denmark
| | - Karin Mogensen
- Department of Urology, Herlev & Gentofte Hospitals, Copenhagen University, Hellerup, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics Faculty of Health and Medical Sciences, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Lyseng-Williamson KA. Hexaminolevulinate: a profile of its use with blue-light cystoscopy in the diagnosis of bladder cancer. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Mogensen K, Glenthøj A, Toft BG, Scheike T, Hermann GG. Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy: an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre? Scand J Urol 2017; 51:376-380. [DOI: 10.1080/21681805.2017.1353542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Karin Mogensen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anders Glenthøj
- Department of Pathology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Grønkær Toft
- Department of Pathology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Scheike
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gregers Gautier Hermann
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Malmström PU. Half a decade of fluorescence in the bladder. Scand J Urol 2017; 51:219-227. [PMID: 28657392 DOI: 10.1080/21681805.2017.1329903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Per-Uno Malmström
- a Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
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Malmström PU, Agrawal S, Bläckberg M, Boström PJ, Malavaud B, Zaak D, Hermann GG. Non-muscle-invasive bladder cancer: a vision for the future. Scand J Urol 2017; 51:87-94. [PMID: 28535714 DOI: 10.1080/21681805.2017.1283359] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The management of non-muscle-invasive bladder cancer (NMIBC) has evolved from the first reports on bladder endoscopy and transurethral resection to the introduction of adjuvant intravesical treatment. However, disease recurrence and progression remain an ongoing risk, placing a heavy burden on healthcare resources and on patients' quality of life. Deeper understanding of the molecular basis of the disease and developments in optics, lasers and computer science are already offering opportunities to revolutionize care and improve long-term prognosis. This article discusses developments likely to cause a paradigm shift towards the delivery of personalized care and reduced burden of disease in NMIBC.
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Affiliation(s)
- Per-Uno Malmström
- a Department of Urology, Division of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Sachin Agrawal
- b Department of Urology, Ashford & St Peter's NHS Trust , St Peter's Hospital , Chertsey , UK
| | - Mats Bläckberg
- c Department of Urology and Surgery , Helsingborg Hospital , Helsingborg , Sweden
| | - Peter J Boström
- d Department of Urology , Turku University Hospital , Turku , Finland
| | - Bernard Malavaud
- e Department of Urology , Toulouse Cancer Institute , Toulouse , France
| | - Dirk Zaak
- f Department of Urology , Traunstein Hospital , Traunstein , Germany
| | - Gregers G Hermann
- g Department of Urology , Herlev & Gentofte Hospital, University of Copenhagen , Herlev , Denmark
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Lindvold LR, Hermann GG. An optical method for reducing green fluorescence from urine during fluorescence-guided cystoscopy. Methods Appl Fluoresc 2016; 4:045002. [DOI: 10.1088/2050-6120/4/4/045002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Kata SG, Aboumarzouk OM, Zreik A, Somani B, Ahmad S, Nabi G, Buist R, Goodman C, Chlosta P, Golabek T, Moseley H. Photodynamic diagnostic ureterorenoscopy: A valuable tool in the detection of upper urinary tract tumour. Photodiagnosis Photodyn Ther 2016; 13:255-260. [DOI: 10.1016/j.pdpdt.2015.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/27/2022]
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Hermann GG, Mogensen K, Lindvold LR, Haak CS, Haedersdal M. Office-based transurethral devascularisation of low grade non-invasive urothelial cancer using diode laser. A feasibility study. Lasers Surg Med 2015; 47:620-5. [PMID: 26373344 DOI: 10.1002/lsm.22402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Frequent recurrence of non-muscle invasive bladder tumours (NMIBC) requiring transurethral resection of bladder tumour (TUR-BT) and lifelong monitoring makes the lifetime cost per patient the highest of all cancers. A new method is proposed for the removal of low grade NMIBCs in an office-based setting, without the need for sedation and pain control and where the patient can leave immediately after treatment. STUDY DESIGN/PATIENTS AND METHODS An in vitro model was developed to examine the dose/response relationship between laser power, treatment time, and distance between laser fibre and target, using a 980 nm diode laser and chicken meat. The relationship between depth and extent of tissue destruction and the laser settings was measured using microscopy and non-parametric statistical analysis. A patient with low grade stage Ta tumour and multiple comorbidity, and therefore not fit for general anaesthesia, had a tumour devascularised using the laser at the tumour base, in the outpatient department. The tumour was left in the bladder. RESULTS In the in vitro model, depth of tissue destruction increased with laser illumination up to 30 seconds, where median depth was 4.1 mm. With longer illumination the tissue destruction levelled off. The width of tissue destruction was 2-3 mm independent of laser illumination time. The in vivo laser treatments devascularised the tumour, which was later shed from the mucosa and passed out with the urine in the days following treatment. Pain score was 0 on a visual log scale (0-10). The tumour had completely disappeared two weeks after treatment. CONCLUSION This diode laser technique may provide almost pain-free office-based treatment of low grade urothelial cancer using flexible cystoscopes in conscious patients. A prospective randomised study will be scheduled to compare the technique with standard TUR-BT in the operating theatre.
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Affiliation(s)
- Gregers G Hermann
- Department of Urology, Bispebjerg/Frederiksberg Hospital, Copenhagen University, Ndr. Fasan vej 57, DK-2000, Frederiksberg
| | - Karin Mogensen
- Department of Urology, Bispebjerg/Frederiksberg Hospital, Copenhagen University, Ndr. Fasan vej 57, DK-2000, Frederiksberg
| | - Lars R Lindvold
- Centre for Nuclear Technologies (Nutech), Technical University of Denmark (DTU), DK-4000 Roskilde, Denmark
| | - Christina S Haak
- Department of Dermatology, Bispebjerg Hospital, Copenhagen University, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, Copenhagen University, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
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Pignot G. [Role of blue-light cystoscopy in the management of non-muscle invasive bladder cancer]. Prog Urol 2015; 25:607-15. [PMID: 26088583 DOI: 10.1016/j.purol.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
Blue-light cystoscopy aims to facilitate the detection of bladder tumors in order to optimize the completeness of resection. We performed a literature analysis using data from Medline and according to PRISMA guidelines. Several meta-analyses have confirmed the interest of the blue-light cystoscopy in terms of improved detection rate and disease-free survival compared to standard white-light cystoscopy. These benefits outweigh the initial costs related to the acquisition of specific equipment, allowing an improvement in quality-adjusted life-years and a reduction of costs over time. Indications vary according to guidelines and must take into account equipment and logistic constraints on each center. The objective of this article is to make a focus on the role and the interest of blue-light cystoscopy in the management of NMIBC in 2015.
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Affiliation(s)
- G Pignot
- Service d'urologie, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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Lotan Y. Promises and challenges of fluorescence cystoscopy. Urol Oncol 2015; 33:261-4. [DOI: 10.1016/j.urolonc.2015.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
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18
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Wang QH, Ji ZG, Chen ZG, Li HZ, Fan H, Fan XR, Shi BB, Fang Y. Serum CA 19-9 as a good prognostic biomarker in patients with bladder cancer. Int J Surg 2015; 15:113-6. [PMID: 25647541 DOI: 10.1016/j.ijsu.2015.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/18/2014] [Accepted: 01/29/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bladder cancer (BC) is the second leading malignant tumors of the genitourinary system. CA 19-9 has served as a diagnostic and prognostic marker for pancreatic carcinoma for years. In recent year, although a few studies have evaluated the roles of CA 19-9 in BC, the results are conflicting and the number of the patients studied is very small. AIM To investigate the potential of serum CA 19-9 to serve as a diagnostic and prognostic marker of BC in a larger number of patients. METHODS A total of 272 (144 BC patients and 128 healthy subjects) were enrolled. Patients were followed-up routinely at 3-month intervals for 5 years. Serum CA 19-9 level was detected by ELISA. RESULTS CA 19-9 level was much higher than that in healthy subjects (43.69 ± 6.92 U/ml vs. 12.31 ± 4.39 U/ml, p < 0.001). However, when the value of 37 U/ml of serum CA 19-9 was used as the cut-off value for BC the sensitivity of CA 19-9 for BC was dropped to 38.8%. CA 19-9 was much higher in muscle invasive tumor subgroup than that in superficial tumor subgroup (38.09 ± 7.14 U/ml vs. 20.71 ± 4.15 U/ml, p < 0.027). CA 19-9 level was comparable in both subgroups (29.78 ± 5.07 U/ml vs. 26.13 ± 5.97 U/ml, p = 0.565). BC patients with more than 5 years survival time had lower serum CA 19-9 level than the rest (15.86 U/ml vs 46.68 U/ml, p < 0.001). Survival rate (>5 years) of patients with lower CA 19-9 levels (<29 U/ml) was significantly increased in comparison to those with elevated serum CA 19-9 levels (>29 U/ml) (p < 0.001). CONCLUSIONS serum CA 19-9 is not a good diagnostic maker, but a very powerful prognostic marker for BC. Such a study might be helpful for urologists to manage patients with BC.
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Affiliation(s)
- Qing-hai Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Zhi-gang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Zhi-gang Chen
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Han-zhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Hua Fan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Xin-rong Fan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Bing-bing Shi
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China.
| | - Yujiang Fang
- Department of Microbiology & Immunology, Des Moines University, College of Osteopathic Medicine, Des Moines, IA 50312, USA; Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.
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Bach T, Muschter R, Herrmann TR, Knoll T, Scoffone CM, Laguna MP, Skolarikos A, Rischmann P, Janetschek G, De la Rosette JJ, Nagele U, Malavaud B, Breda A, Palou J, Bachmann A, Frede T, Geavlete P, Liatsikos E, Jichlinski P, Schwaibold HE, Chlosta P, Martov AG, Lapini A, Schmidbauer J, Djavan B, Stenzl A, Brausi M, Rassweiler JJ. Technical solutions to improve the management of non-muscle-invasive transitional cell carcinoma: summary of a European Association of Urology Section for Uro-Technology (ESUT) and Section for Uro-Oncology (ESOU) expert meeting and current and future pers. BJU Int 2014; 115:14-23. [DOI: 10.1111/bju.12664] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thorsten Bach
- Department of Urology; Asklepios Hospital Harburg; Hamburg Germany
| | - Rolf Muschter
- Department of Urology; Diakoniekrankenhaus Rotenburg; Rotenburg Germany
| | | | - Thomas Knoll
- Department of Urology; Klinikum Sindelfingen-Böblingen; Sindelfingen Germany
| | | | - M. Pilar Laguna
- Department of Urology; AMC University of Amsterdam; Amsterdam The Netherlands
| | - Andreas Skolarikos
- Second Department of Urology; Sismanoglio Hospital, Athens Medical School; Athens Greece
| | - Pascal Rischmann
- Department of Urology; Rangueil University Hospital; Toulouse France
| | - Günter Janetschek
- Department of Urology; Paracelsius Medical University; Salzburg Austria
| | | | - Udo Nagele
- Department of Urology; LKH Hall; Hall in Tirol Austria
| | - Bernard Malavaud
- Department of Urology; Rangueil University Hospital; Toulouse France
| | - Alberto Breda
- Department of Urology; Fundacio Puigvert; Autonoma University of Barcelona; Barcelona Spain
| | - Juan Palou
- Department of Urology; Fundacio Puigvert; Autonoma University of Barcelona; Barcelona Spain
| | | | - Thomas Frede
- Department of Urology; Helios Klinik Müllheim; Müllheim Germany
| | - Petrisor Geavlete
- Department of Urology; Saint John Emergency Clinical Hospital; Bucharest Romania
| | | | | | | | - Piotr Chlosta
- Department of Urology; Centre of Oncology; Kielce Poland
| | - Alexey G. Martov
- Department of Endourology; Municipal Clinical Hospital #57 of Moscow; Moscow Russian Federation
| | - Alberto Lapini
- Department of Urology; Careggi Hospital, University of Florence; Florence Italy
| | | | - Bob Djavan
- Department of Urology; Medical University of Vienna; Vienna Austria
| | - Arnulf Stenzl
- Department of Urology; University of Tübingen; Tübingen Germany
| | - Mauricio Brausi
- Department of Urology; New Estense S. Agostino Hospital Ausl Modena; Modena Italy
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20
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Witjes JA, Babjuk M, Gontero P, Jacqmin D, Karl A, Kruck S, Mariappan P, Palou Redorta J, Stenzl A, van Velthoven R, Zaak D. Clinical and cost effectiveness of hexaminolevulinate-guided blue-light cystoscopy: evidence review and updated expert recommendations. Eur Urol 2014; 66:863-71. [PMID: 25001887 DOI: 10.1016/j.eururo.2014.06.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Non-muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence risk, partly because of the persistence of lesions following transurethral resection of bladder tumour (TURBT) due to the presence of multiple lesions and the difficulty in identifying the exact extent and location of tumours using standard white-light cystoscopy (WLC). Hexaminolevulinate (HAL) is an optical-imaging agent used with blue-light cystoscopy (BLC) in NMIBC diagnosis. Increasing evidence from long-term follow-up confirms the benefits of BLC over WLC in terms of increased detection and reduced recurrence rates. OBJECTIVE To provide updated expert guidance on the optimal use of HAL-guided cystoscopy in clinical practice to improve management of patients with NMIBC, based on a review of the most recent data on clinical and cost effectiveness and expert input. EVIDENCE ACQUISITION PubMed and conference searches, supplemented by personal experience. EVIDENCE SYNTHESIS Based on published data, it is recommended that BLC be used for all patients at initial TURBT to increase lesion detection and improve resection quality, thereby reducing recurrence and improving outcomes for patients. BLC is particularly useful in patients with abnormal urine cytology but no evidence of lesions on WLC, as it can detect carcinoma in situ that is difficult to visualise on WLC. In addition, personal experience of the authors indicates that HAL-guided BLC can be used as part of routine inpatient cystoscopic assessment following initial TURBT to confirm the efficacy of treatment and to identify any previously missed or recurrent tumours. Health economic modelling indicates that the use of HAL to assist primary TURBT is no more expensive than WLC alone and will result in improved quality-adjusted life-years and reduced costs over time. CONCLUSIONS HAL-guided BLC is a clinically effective and cost-effective tool for improving NMIBC detection and management, thereby reducing the burden of disease for patients and the health care system. PATIENT SUMMARY Blue-light cystoscopy (BLC) helps the urologist identify bladder tumours that may be difficult to see using standard white-light cystoscopy (WLC). As a result, the amount of tumour that is surgically removed is increased, and the risk of tumour recurrence is reduced. Although use of BLC means that the initial operation costs more than it would if only WLC were used, over time the total costs of managing bladder cancer are reduced because patients do not need as many additional operations for recurrent tumours.
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Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Marek Babjuk
- Department of Urology, Motol Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Didier Jacqmin
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Alexander Karl
- Department of Urology, Ludwig Maximilians University, Munich, Germany
| | - Stephan Kruck
- Department of Urology, Eberhard Karls University, Tübingen, Germany
| | | | - Juan Palou Redorta
- Urologic Oncology Unit, Department of Urology, Puigvert Foundation, Barcelona, Spain
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University, Tübingen, Germany
| | | | - Dirk Zaak
- Department of Urology, Traunstein Hospital, Traunstein, Germany
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Ke Z, Lai Y, Ma X, Lil S, Huang W. Diagnosis of bladder cancer from the voided urine specimens using multi-target fluorescence in situ hybridization. Oncol Lett 2014; 7:325-330. [PMID: 24396440 PMCID: PMC3881196 DOI: 10.3892/ol.2013.1744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/12/2013] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to evaluate the diagnostic value of chromosomal analysis by fluorescence in situ hybridization (FISH) for bladder cancer in light of the histological diagnosis. Several valuable observations using FISH technologies in voided urine cells were also reported. The multi-target FISH-containing probes for the centromeres of chromosomes 3, 7 and 17 and the 9p21 locus were applied to cytospin specimens prepared from voided urine. Urine samples from 53 bladder cancer patients and 30 patients with benign alterations were used for this study. The histological observations of surgical resection specimens showed that the specificity and sensitivity for the technique were 100.0 and 88.0%, respectively. Statistical analyses showed that there was no significant correlation between FISH-positive rate and the tumor stage/grade (P<0.05). However, the proportion of tumor cells with genetic abnormalities positively correlated with the tumor stage (P<0.01). Furthermore, the number of abnormal cells in muscle-invasive pT2 was significantly higher than that in non-muscle-invasive pTa, pT1 (P<0.01). Of 50 patients with bladder cancer, polysomies of chromosomes 3, 7 and 17 were detected in 84.0, 48.0 and 78.0% of cases, respectively, and loss of the 9p21 gene was detected in 80.0% of cases. In addition, the detailed results from different urine specimens showed that FISH assay was required. FISH assay for chromosomes 3, 7 and 17 and 9p21 has a high specificity and sensitivity in the detection of bladder cancer and may reduce the necessity for cytoscopy treatment.
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Affiliation(s)
- Zunfu Ke
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yuanhua Lai
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Xudong Ma
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, P.R. China
| | - Shuhua Lil
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Wenhua Huang
- Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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22
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Yuan H, Qiu J, Liu L, Zheng S, Yang L, Liu Z, Pu C, Li J, Wei Q, Han P. Therapeutic outcome of fluorescence cystoscopy guided transurethral resection in patients with non-muscle invasive bladder cancer: a meta-analysis of randomized controlled trials. PLoS One 2013; 8:e74142. [PMID: 24058522 PMCID: PMC3772837 DOI: 10.1371/journal.pone.0074142] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/28/2013] [Indexed: 02/05/2023] Open
Abstract
Objectives To conduct a meta-analysis of randomized controlled trials (RCTs) to assess the therapeutic outcome of fluorescence cystoscopy (FC) guided transurethral resection (TUR) in non-muscle invasive bladder cancer (NMIBC). Materials and Methods Relevant RCTs were identified from electronic database (MEDLINE, Embase and the Cochrane Library). The proceedings of relevant congress were also searched. The primary parameters were recurrence rate, the time to fist recurrence, recurrence free survival rate (RFS) and progression rate. Results 12 RCTs including 2258 patients, which were identified for analysis in our study. Our study showed that the FC group have lower recurrence rate than the white light cystoscopy (WLC) group with statistically significant difference (OR: 0.5; p<0.00001). The time of the FC group first recurrence delayed significantly 7.39 weeks than WLC group (MD: 7.39 weeks; p<0.0001). There was a statistically significant difference in favor of FC in RFS at 1 yr (HR: 0.69; p<0.00001) and 2 yrs (HR: 0.65; p=0.0004). However, the FC group cannot significantly reduce the rate of progression into muscle invasive bladder cancer compared with the WLC group (OR: 0.85; p=0.39). Conclusions FC guided TUR was demonstrated to be an effective procedure for delaying recurrence of NMIBC. Unfortunately, FC guided TUR could not significantly decrease the rate of progression into muscle invasive bladder cancer.
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Affiliation(s)
- Haichao Yuan
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Jianguo Qiu
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Liangren Liu
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Shuo Zheng
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Zhenghua Liu
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Chunxiao Pu
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Jinhong Li
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, P. R. China
- * E-mail:
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23
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van Lingen AV, Witjes JA. Current intravesical therapy for non-muscle invasive bladder cancer. Expert Opin Biol Ther 2013; 13:1371-85. [DOI: 10.1517/14712598.2013.824421] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Aagaard MF, Mogensen K, Hermann GG. Delayed healing at transurethral resection of bladder tumour sites after immediate postoperative mitomycin C instillation. Scand J Urol 2013; 48:222-4. [PMID: 23870006 DOI: 10.3109/21681805.2013.820787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The most common reactions to mitomycin C are dysuria and drug-related palmar and genital desquamation. This report describes two cases of delayed healing of the mucosa at resection sites after transurethral resection of bladder tumours, most likely due to immediate postoperative mitomycin C instillation of the bladder.
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Affiliation(s)
- Mark F Aagaard
- Department of Urology, Frederiksberg Hospital , Frederiksberg , Denmark
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25
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Rink M, Babjuk M, Catto JWF, Jichlinski P, Shariat SF, Stenzl A, Stepp H, Zaak D, Witjes JA. Hexyl aminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: a critical review of the current literature. Eur Urol 2013; 64:624-38. [PMID: 23906669 DOI: 10.1016/j.eururo.2013.07.007] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Controversy exists regarding the therapeutic benefit and cost effectiveness of photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) or hexyl aminolevulinate (HAL) in addition to white-light cystoscopy (WLC) in the management of non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE To systematically evaluate evidence regarding the therapeutic benefits and economic considerations of PDD in NMIBC detection and treatment. EVIDENCE ACQUISITION We performed a critical review of PubMed/Medline, Embase, and the Cochrane Library in October 2012 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and Standards for the Reporting of Diagnostic Accuracy Studies (STARD) criteria. Forty-four publications were selected for inclusion in this analysis. EVIDENCE SYNTHESIS Included reports used 5-ALA (in 26 studies), HAL (15 studies), or both (three studies) as photosensitising agents. PDD increased the detection of both papillary tumours (by 7-29%) and flat carcinoma in situ (CIS; by 25-30%) and reduced the rate of residual tumours after transurethral resection of bladder tumour (TURBT; by an average of 20%) compared to WLC alone. Superior recurrence-free survival (RFS) rates and prolonged RFS intervals were reported for PDD, compared to WLC in most studies. PDD did not appear to reduce disease progression. Our findings are limited by tumour heterogeneity and a lack of NMIBC risk stratification in many reports or adjustment for intravesical therapy use in most studies. Although cost effectiveness has been demonstrated for 5-ALA, it has not been studied for HAL. CONCLUSIONS Moderately strong evidence exists that PDD improves tumour detection and reduces residual disease after TURBT compared with WLC. This has been shown to improve RFS but not progression to more advanced disease. Further work to evaluate cost effectiveness of PDD is required.
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Affiliation(s)
- Michael Rink
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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26
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Current world literature. Curr Opin Urol 2012; 22:432-43. [PMID: 22854603 DOI: 10.1097/mou.0b013e3283572fe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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