MP22-09 FLEXIBLE PHOTODYNAMIC DIAGNOSIS OF THE BLADDER – READY FOR THE OUTPATIENT SETTING?

Abstract

You have accessJournal of UrologyBladder Cancer: Detection & Screening1 Apr 2014MP22-09 FLEXIBLE PHOTODYNAMIC DIAGNOSIS OF THE BLADDER – READY FOR THE OUTPATIENT SETTING? Alexander Karl, Patrick Weidlich, Christoph Adam, Peter Stanislaus, Thomas Hoffmann, Stefan Tritschler, Christian Stief, and Dirk Zaak Alexander KarlAlexander Karl More articles by this author , Patrick WeidlichPatrick Weidlich More articles by this author , Christoph AdamChristoph Adam More articles by this author , Peter StanislausPeter Stanislaus More articles by this author , Thomas HoffmannThomas Hoffmann More articles by this author , Stefan TritschlerStefan Tritschler More articles by this author , Christian StiefChristian Stief More articles by this author , and Dirk ZaakDirk Zaak More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.857AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the feasibilty and detection rate of flexible HAL-cystoscopy using a new chip-on-the-tip technology in patients with the suspicion of bladder cancer. In this study the performance of photodynamic diagnosis (PDD) and white light (WL) endoscopy using flexible and rigid cystoscopes were compared. METHODS In total 30 patients were included in this two-center study. The flexible chip on the tip endoscope (Storz) and the rigid system (Storz) were both used for diagnostic cystoscopy in the same patient. In preparation for PDD Hexylaminolevulinate (HAL) was used. Two experienced surgeons in each participating institution were involved. In every patient one of these surgeons performed the examination in white light and PDD using a rigid instrument first. Then another blinded surgeon performed a flexible cystoscopy using WL and PDD in the same patient again. All blinded findings were captured on a specially designed documentation sheet. RESULTS In all 30 patients flexible cystoscopy could be performed without any technical problems. In the WL setting the overall sensivitiy for flexible cystoscopy was 92% (22/24) vs. 83% (20/24) with the rigid endoscope. The specificity was 50% for flexible WL vs. 33% for rigid WL. The accuracy of flexible WLwas higher (83%) compared to rigid (73 %). There was an accordance of the two methods of 83% (25/30) with a Cohen's kappa of k=0.44 (p=0.007). Respecting only the results that were acquired in PDD mode, there was no difference in sensitiviy, specificity and accuracy between the two methods (p <0.001). The quality of fluorescence was judged by every examiner for flexible and rigid PDD. For quality assessment four different subjective levels for fluorescence (no, low, medium, high) were used. In 24 of 30 cases there was the same level documented in flexible and rigid. This represents an accuracy of 80% (p<0.001). During the whole study there were observed no side effects caused by the PDD or the flexible approach. Tangential views of the bladder resulting in false positive fluorescence could be avoided using the flexible endoscope. CONCLUSIONS Flexible PDD using the chip on the tip technology was feasible with an excellent picture quality. Sensitivity of flexible PDD was equivalent to the current gold standard – the rigid endoscopy. There was no loss in fluorescence intensity or diagnostic information using the flexible cystoscope. Therefore the outpatient use of flexible PDD seems reasonable in the diagnosis and follow up of bladder cancer patients. However larger clinical studies need to further verify the efficiency of this new equipment. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e237-e238 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alexander Karl More articles by this author Patrick Weidlich More articles by this author Christoph Adam More articles by this author Peter Stanislaus More articles by this author Thomas Hoffmann More articles by this author Stefan Tritschler More articles by this author Christian Stief More articles by this author Dirk Zaak More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...