Cystoscopie en fluorescence pour les tumeurs superficielles de vessie : apport de l’hexaminolévulinate (Hexvix ®) et du diagnostic photodynamique

Abstract

Transurethral resection of the bladder is one of the most frequent procedures for a urologist, and it constitutes the basis for the diagnosis and treatment of superficial tumors of the bladder. However, flat lesions of carcinoma in situ (CIS) are often not picked up by a standard cystoscopy, and the premature recurrence of a bladder tumor from as early on as the first cystoscopy reveals the sometimes incomplete character of the initial resection. The aim of fluorescence was to make “visible” the imperfections of the standard cystoscopy. Fluorescent cystoscopy (in blue light) showed its superiority in the detection of superficial bladder tumors, and especially of CIS, compared to standard cystoscopy using white light. This photodynamic diagnosis (PDD) also allows to significantly reduce the rate of residual tumors and the rate of recurrence after TURB. Results from wider and more random tests and in terms of progression-free survival and specific survival are awaited. From now on, the AFU (Association Française d’Urologie) recommends the PDD in cases of high grade positive cytology, the surveillance of high risk bladder tumors (pT1G and CIS), of multifocal bladder tumors, of tumors of more than 30 mm and of premature recurring tumors after TURB.