1771 RANDOMISED PROSPECTIVE EVALUATION OF FLUORESCENCE FOR TRANSURETHRAL RESECTION OF THE BLADDER: WHAT IS THE REAL GAIN FOR DIAGNOSIS?

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial (II)1 Apr 20131771 RANDOMISED PROSPECTIVE EVALUATION OF FLUORESCENCE FOR TRANSURETHRAL RESECTION OF THE BLADDER: WHAT IS THE REAL GAIN FOR DIAGNOSIS? Yann NEUZILLET, Charlotte METHORST, Marc SCHNEIDER, Mathieu ROUANNE, Thierry LEBRET, and Henry BOTTO Yann NEUZILLETYann NEUZILLET Suresnes, France More articles by this author , Charlotte METHORSTCharlotte METHORST Suresnes, France More articles by this author , Marc SCHNEIDERMarc SCHNEIDER Colmar, France More articles by this author , Mathieu ROUANNEMathieu ROUANNE Suresnes, France More articles by this author , Thierry LEBRETThierry LEBRET Suresnes, France More articles by this author , and Henry BOTTOHenry BOTTO Suresnes, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the gain provided by fluorescence for diagnostic cystoscopy during transurethral resection of bladder (TURB) in patients with at least one bladder tumor diagnosed by endoscopy, a priori non-muscle invasive, and high grade urine cytology. METHODS Randomised prospective study. From November 2009 to September 2012, 151 patients were randomised in two centres for the first TURB with or without fluorescence using Hexaminolevulinate (HAL) instilled at least 1 hour before TURB. A second TURB with fluorescence was systematically programmed 6 weeks afterwards. The number of tumours detected using white (WL) and fluorescent (FL) light and their pathological features were recorded and compared between the two arms. RESULTS One hundred and thirty-three men and 18 women (11.9%) aged 74 ± 14 years had a first TURB, including 72 (47.7%) with HAL. The number of tumours visualised in WL and FL in patients with HAL was 2.66 ± 2.26 and 3.04 ± 2.54 respectively. In the 79 patients without HAL, 2.42 ± 1.72 tumours were seen in WL. Twenty-two patients and 6 patients who had a cystectomy, respectively, for a muscle-invasive tumour or a T1G3 + CIS tumour diagnosed by the first TURB, 5 patients T0, 15 patients refusing the 2nd TURB (including 5 for Ta tumours of low grade and 5 due to worsening of their general condition), 2 intercurrent deaths from cardiac causes and 8 patients lost to follow-up have not had a 2nd TURB. Ninety-three patients (62%) had a 2nd REV. The number of tumours visualised in WL and FL in 43 patients who underwent the first TURB with HAL was 2.02 ± 1.66 and 2.56 ± 2.10 respectively. For the 50 patients who had the first TURB without HAL, the number of tumours visualised in WL and FL was 1.90 ± 2.29 and 2.06 ± 2.45 respectively. CONCLUSIONS TURB with HAL fluorescence in patients with high grade urine cytology provides a gain in the number of tumours diagnosed compared to WL alone. This gain was observed during the first and 2nd with TURB with HAL. However, the differences observed in this prospective randomised study were not significant. With HAL when 1st TURB Without HAL when 1st TURB p = Age 74 ± 14 years 74 ± 14 years 0.93 women 11.1% 12.7% 0.77 Tumours (WL) 1st TURB 2.66 ± 2.26 2.42 ± 1.72 0.65 n (%) T2 diagnosed by 1st TURB 10 (14.3%) 15 (19.2%) 0.69 n (%) T2 diagnosed by 2nd TURB 1 (2.3%) 2 (4.0%) 0.54 n (%) cis diagnosed by 1st TURB 15 (21.7%) 13 (16.9%) 0.84 n (%) cis diagnosed by 2nd TURB 9 (20.9%) 14 (29.8%) 0.47 Tumours (WL) 2nd TURB 1,97 ± 1,79 2,20 ± 2,26 0.63 n (%) T0 diagnosed by 1st TURB 3 (4.6%) 5 (6.8%) 0.72 n (%) T0 diagnosed by 2nd TURB 23 (53.5%) 25 (48.0%) 0.25 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e728 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yann NEUZILLET Suresnes, France More articles by this author Charlotte METHORST Suresnes, France More articles by this author Marc SCHNEIDER Colmar, France More articles by this author Mathieu ROUANNE Suresnes, France More articles by this author Thierry LEBRET Suresnes, France More articles by this author Henry BOTTO Suresnes, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...