Conventional Transurethral Resection Of Bladder Tumor Research Articles

Solitary fibrous tumor of urinary bladder in a female patient and transurethral enucleation of tumor

Solitary fibrous tumors are rare neoplasms, initially defined in visceral pleura. Recently, they have been noticed to have ubiquitous distribution of human body. Solitary fibrous tumor of bladder is extremely rare especially in the females. We are presenting a bladder solitary fibrous tumor case of 62-years-old female patient who underwent transurethral enucleation instead of conventional transurethral resection of bladder tumor. According to our research, this is the fourth case of solitary fibrous tumor in a female urinary bladder in the literature.

New techniques for bladder tumor resection: are they better than conventional TURBT?

New techniques for bladder tumor resection: are they better than conventional TURBT?

A novel transurethral resection technique for superficial bladder tumor: retrograde en bloc resection

BackgroundTransurethral resection of bladder tumor (TURBT) is the standard approach to bladder tumors but suffers from several disadvantages. The aim of this study was to evaluate the safety and efficacy of a novel procedure of retrograde en bloc resection of bladder tumor (RERBT) with conventional monopolar resection electrode for the treatment of superficial bladder tumors.MethodsRERBT and conventional TURBT (C-TURBT) were conducted, respectively, in 40 and 50 patients diagnosed with superficial papillary bladder tumors. In the RERBT group, the tumors were en bloc removed retrogradely under direct vision using a conventional monopolar electrode. Patients’ clinicopathological, intraoperative, and postoperative data were compared retrospectively between the RERBT and C-TURBT groups.ResultsOf the 90 patients, 40 underwent RERBT and 50 underwent C-TURBT. Both groups were comparable in clinicopathological characteristic. RERBT could be performed as safely and effectively as C-TURBT. There were no significant differences in operative time and surgical complications. The cumulative recurrence rates between groups were similar during up to 18 months follow-up. The detrusor muscle could be identified pathologically in 100% of RERBT tumor specimens and the biopsy of tumor bases, but only in 54 and 70%, respectively, of C-TURBT samples (P < 0.01).ConclusionsThe RERBT technique is feasible and safe for superficial bladder tumors using conventional monopolar resection setting, with the advantages of adequate tumor resection and the ability to collect good quality tumor specimens for pathological diagnosis and staging compared to conventional TURBT.

Transurethral en bloc resection of nonmuscle invasive bladder cancer: trend or hype.

Inherent limitations of conventional transurethral resection of bladder tumors as the standard approach for diagnosis and treatment of bladder cancer are well know: staging error because of insufficient assessment of resection depth as well as intravesical tumor fragmentation that complicates histopathological evaluation. The purpose of this review is to present recent clinical data on en bloc resection of bladder tumor (ERBT) that has been demonstrated to offer high potential to overcome these limitations. The recently published studies confirm the results our previous reviews for laser ERBT and current-based ERBT from 2014. ERBT provides a better resection quality with up to 95% presence lamina muscularis propria as surrogate marker for quality. It can be performed using all energy sources. Available data demonstrate with all due limitations of reporting quality no relevant difference with regard to perioperative morbidity compared with conventional transurethral resection of bladder tumors. No conclusions can be drawn regarding the impact of ERBT on recurrence as data are controversial. ERBT has gained momentum in the past years. The hypothesized advantages over conventional TURBT seem to manifestate for tumors up to 3 or 4 cm in size with regard to staging, specimen quality, and analyzability in pathological evaluation in general. The impact on recurrence remains to be defined by further studies.

PD11-04 TRANSURETHRAL ENDOSCOPIC SUBMUCOSAL EN BLOT DISSECTION FOR NON-MUSCLE INVASIVE BLADDER TUMOR: A PROSPECTIVE COMPARISON STUDY OF HYBRIDKNIFE ASSISTED VERSUS CONVENTIONAL DISSECTION TECHNIQUE

INTRODUCTION AND OBJECTIVES: Endoscopic submucosal dissection (ESD), an emerging new technology, had been reported to safely, effectively and en blot dissection method for gastrointestinal epithelial tumors treatment, which maybe a better en blot desection approach for NMIBC treatment. The present study is to compare the efficacy and safety of bladder tumor-endoscopic submucosal dissection (BT-ESD) and conventional transurethral resection of bladder cancer (TURBT) in patients with non-muscle invasive bladder tumor (NMIBC). METHODS: A prospective trial was carried out in Shaanxi Provincial People’s Hospital (Shaanxi, China), 75 patients eligible suspicious NMIBC, between November 2013 and Oct 2014, were constructively enrolled in and randomized to use of either the BT-ESD (ESD Group, 38 cases) or the TURBT treatment (TURBT group, 37 cases). The operation time, blood loss, postoperative bladder irrigation time, catheter indwelling time, hospital stay, complications and 1-year tumor recurrence rate were compared between 2 groups. RESULTS: A total of 75 patients with comparable characteristics between groups were included. The ESD group showed increased average operation time than TURBT group (30.2 9.2 min v.s 15.08 6.1 min, p< 0.05), respectively, no significant difference were found in the smaller tumor (0-2cm). The postoperative bladder irrigation time, catheter indwelling time and hospital stay in BT-ESD group were significantly shorter than TURBT group (8.3 2.8h, 2.3 0.9d and 3.0 1.3d for ESD group;16.7 3.6h, 4.8 1.3d and 6.5 1.8d for TURBT group). In addition, the BT-ESD group showed decreased overall incidence of complications (7.9% v.s 18.9%, p<0.05) and 1-year tumor recurrence rate (5.3% v.s 21.6%, p < 0.05). CONCLUSIONS: We conclude that BT-ESD as a novel approach used for NMIBT appears to be a feasibly safe and applicable. Compared with conventional TURBT, BT-ESD applies an en bloc resection technique following the principles of oncologic surgery by using HybirdHnife to facilitate histopathologic assessment more accurate and reach a R0 resection. This is much critical for planning strategy of intravesical instillation, assessing prognosis and determining the protocol of follow-up, with respective potential advantages in decreasing rates of tumor recurrence and progression, and reducing socioeconomic costs. Clearly, BT-ESD appears to benefit the patients and is worth popularizing application in clinic.

MP26-04 SAFETY, EFFICACY AND 12-MONTHS RECURRENCE RATE OF LASER VS. ELECTRICAL EN BLOC RESECTION OF UROTHELIUM CARCINOMA OF THE BLADDER: RESULTS OF THE EBRUC TRIAL

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2015MP26-04 SAFETY, EFFICACY AND 12-MONTHS RECURRENCE RATE OF LASER VS. ELECTRICAL EN BLOC RESECTION OF UROTHELIUM CARCINOMA OF THE BLADDER: RESULTS OF THE EBRUC TRIAL Mario W. Kramer, Jens J. Rassweiler, Jan Klein, Alexey Martov, Nikolay Baykov, Rodolfo Hurle, Guenter Janetschek, Lukas Lusuardi, Mathias Wolters, Mahmoud Abbas, Armin Leitenberger, Markus Riedl, Udo Nagele, Axel S. Merseburger, Markus A. Kuczyk, Marko Babjuk, and Thomas R.W. Herrmann Mario W. KramerMario W. Kramer More articles by this author , Jens J. RassweilerJens J. Rassweiler More articles by this author , Jan KleinJan Klein More articles by this author , Alexey MartovAlexey Martov More articles by this author , Nikolay BaykovNikolay Baykov More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Guenter JanetschekGuenter Janetschek More articles by this author , Lukas LusuardiLukas Lusuardi More articles by this author , Mathias WoltersMathias Wolters More articles by this author , Mahmoud AbbasMahmoud Abbas More articles by this author , Armin LeitenbergerArmin Leitenberger More articles by this author , Markus RiedlMarkus Riedl More articles by this author , Udo NageleUdo Nagele More articles by this author , Axel S. MerseburgerAxel S. Merseburger More articles by this author , Markus A. KuczykMarkus A. Kuczyk More articles by this author , Marko BabjukMarko Babjuk More articles by this author , and Thomas R.W. HerrmannThomas R.W. Herrmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1126AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The quality of transurethral resection of bladder tumors strongly determines patient's tumor after-care and prognosis. En bloc resection of bladder tumors (ERBT) might improve staging quality, perioperative morbidity and influence tumor recurrence. This is the first European multi-center study which was initiated by ESUT and was conducted to evaluate the safety, efficacy and recurrence rates of electrical vs. laser ERBT. METHODS Transurethral ERBT was performed on 221 prospectively collected patients in six academic centers with either monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative/surgical parameters and 12 months follow-up data were analyzed. RESULTS 156 and 65 patients were treated with electrical and laser ERBT, respectively. Median tumor size was 2.1 cm with biggest up to 5 cm. Detrusor muscle was available in 97.3%. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3% vs. 1.5%, p<0.001). Median operation duration (25 min), postoperative irrigation (1 day) and catheterization time (2 days) as well as hospitalization (3 days) were similar in both groups. Overall complication rate was low (Clavien ≥3, n=6 (2.7%)). Hemoglobin was significantly more decreased after electrical ERBT (p=0.0013), however overall hemoglobin loss was not clinically relevant (0.38 g/dl). 148 patients with first diagnosis of urothelium carcinoma of the bladder were followed for 12 months of which 33 (22.3%) recurred. 63.6% of recurrences occurred out of the ERBT resection field. No difference was noticed between both ERBT groups. CONCLUSIONS ERBT is safe and reliable regardless of the energy source used and offers high quality resections of tumors >1 cm. Recurrence rates did not differ within both groups although the majority of recurrences were noticed out of the ERBT resection field. Laser device might be an alternative for the treatment of patients with higher risk of postoperative bleeding due to its efficient hemostatic effect. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e294 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mario W. Kramer More articles by this author Jens J. Rassweiler More articles by this author Jan Klein More articles by this author Alexey Martov More articles by this author Nikolay Baykov More articles by this author Rodolfo Hurle More articles by this author Guenter Janetschek More articles by this author Lukas Lusuardi More articles by this author Mathias Wolters More articles by this author Mahmoud Abbas More articles by this author Armin Leitenberger More articles by this author Markus Riedl More articles by this author Udo Nagele More articles by this author Axel S. Merseburger More articles by this author Markus A. Kuczyk More articles by this author Marko Babjuk More articles by this author Thomas R.W. Herrmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laser versus electrical en bloc resection of bladder tumors: Results of a European multicenter study (EBRUC).

310 Background: The quality of transurethral resection of bladder tumors strongly determines patient’s tumor after-care and prognosis. En bloc resection of bladder tumors (ERBT) might improve staging quality, perioperative morbidity and influence tumor recurrence. This is the first European multi-center study which was initiated by ESUT and was conducted to evaluate the safety, efficacy and recurrence rates of electrical vs. laser ERBT. Methods: Transurethral ERBT was performed on 221 prospectively collected patients in six academic centers with either monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative/surgical parameters and 12 months follow-up data were analyzed. Results: 156 and 65 patients were treated with electrical and laser ERBT, respectively. Median tumor size was 2.1 cm with biggest up to 5 cm. Detrusor muscle was available in 97.3%. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3% vs. 1.5%, p&lt;0.001). Median operation duration (25 min), postoperative irrigation (1 day) and catheterization time (2 days) as well as hospitalization (3 days) were similar in both groups. Overall complication rate was low (Clavien ≥3, n=6 (2.7%)). Hemoglobin was significantly more decreased after electrical ERBT (p=0.0013), however overall hemoglobin loss was not clinically relevant (0.38 g/dl). 148 patients with first diagnosis of urothelium carcinoma of the bladder were followed for 12 months of which 33 (22.3%) recurred. 63.6% of recurrences occurred out of the ERBT resection field. No difference was noticed between both ERBT groups. Conclusions: ERBT is safe and reliable regardless of the energy source used and offers high quality resections of tumors &gt;1 cm. Recurrence rates did not differ within both groups although the majority of recurrences were noticed out of the ERBT resection field. Laser device might be an alternative for the treatment of patients with higher risk of postoperative bleeding due to its efficient hemostatic effect.

Comparative Study of 2um Laser versus Ho lmium Laser for the Resection of Non-Muscle Invasive Bladder Cancer

Objective: To compare the safety and efficacy of conventional monopolar transurethral resection of bladder tumor (TURBT), 2-micron continuous-wave laser and holmium laser resection techniques in the management of primary nonmuscle invasive bladder tumor (NMIBT). Methods: From January 2009 to January 2013, patients newly diagnosed primary NMIBC were enrolled in this study. The patients were divided into conventional TURBT group (n=70), holmium laser group (n=70) and 2-micron laser group (n=70) randomly. Operative time, postoperative bladder irrigation, catheterization time, hospitalization time, complications included obturator nerve reflex, bladder perforation, blood transfusion, and 2-year tumor recurrence rate were documented in all patients. Results: Characteristics of patients and tumors in all three groups were compared before surgery. There was no significant difference in operative time among the three groups. Compared with the conventional TURBT group, both 2-micron and holmium groups had less intra operative and postoperative complications, including obturator nerve reflex, bladder perforation, and postoperative bladder irritation. There were no significant differences among the three groups in the blood transfusion rate and incidence of urethral stricture. Patients in the 2-micron and holmium groups had less catheterization and hospitalization time than those in the conventional TURBT group. There was no significant difference in the 2-year tumor recurrence rate among the three groups. Conclusion: Our results demonstrated that the use of 2-micron (thulium) laser and holmium laser in the management of NMIBT were superior to conventional monopolar TURBT, while there were no significant differences between 2-micron laser and holmium laser. However, 2-micron laser and holmium laser did not have an obvious advantage over conventional TURBT in 2-year tumor recurrence rate. A longer follow-up period and larger numbers of patients are necessary to demonstrate the present result in the future.

A novel transurethral resection technique for superficial flat bladder tumor: grasp and bite technique.

PurposeTransurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT.Materials and MethodsMonopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups.ResultsOf 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique.ConclusionsThe grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner.

Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014.

Bladder cancer (BC) represents a growing health care problem worldwide. In times of tight budgets and an aging society, new strategies for the transurethral treatment of BC are needed. Laser devices used for tumor vaporization and/or en bloc resection provide an alternative to parvenu strategies. Medline/Cochrane search was performed using following terms: bladder cancer, urothelial carcinoma, laser, en bloc, vaporization, photoablation, holmium, thulium, Ho:YAG, Tm:YAG, HoLRBT and TmLRBT. Last date of search was February 12, 2014. Eighteen publications in English were identified including 800 patients (Ho:YAG = 652 patients and Tm:YAG = 148 patients). Data on en bloc resection techniques were presented in 10 publications, 7 publications provided data of tumor vaporization and one publication presented data on both. Level of evidence based on SIGN is mainly 3 (non-analytic studies); only three studies are level 2 (prospective case control studies). Tumor vaporization seems to be a promising alternative for the treatment of recurrent tumors in selected patients. It can be performed in an office-based approach without the need of general anesthesia. The use of photodynamic diagnostic might enhance surgical quality. The principle of en bloc resection should provide accurate staging in most cases; however, data on this important aspect are missing. Peri- and postoperative complications are scarce. Due to the nature of the energy source, bladder perforation caused by obturator nerve reflex is highly unlikely when using lasers. There is a trend toward decreased infield recurrence rates. Lasers are potentially useful alternatives to conventional TURBT, but systematical assessments using standardized classification systems and well-designed RCTs are needed to make results comparable.

Is en-bloc transurethral resection of bladder tumor for non-muscle invasive bladder carcinoma better than conventional technique in terms of recurrence and progression?: A prospective study

Purpose:Conventional, transurethral resection of bladder tumor (TURBT) involves piecemeal resection of the tumor and has a very high recurrence rate. We evaluated the outcome of en-bloc TURBT (ET) in comparison with conventional TURBT (CT) in non-muscle invasive bladder carcinoma in terms of recurrencew and progression.Materials and Methods:From September 2007 to June 2011, in a prospective non-randomized interventional setting, ET was compared with CT in patients with solitary tumor of 2-4 cm size in terms of recurrence and progression. Pedunculated tumors, size >4 cm, tumors with associated hydroureteronephrosis and biopsy specimen with absent detrusor muscles were excluded. Fisher's exact test and survival analyses were used to compare the demography and the outcome.Results:A total of 21 patients of ET were compared with 24 patients of CT. Mean tumor size was 2.8 cm in ET and 3.3 cm in CT group. Location of tumor, stage and grade were comparable in both groups. Recurrence rate was 28.6% versus 62.5% (P = 0.03) and progression rate was 19% versus 33.3% (P = 0.32) in ET versus CT group respectively. Recurrence free survival was 45.1 (95% CI: 19.0-38 months) and 28.5 (95% CI: 35.4-54.7 months) in ET and CT group (P = 0.018). Progression free survival in ET and CT was 48.32 (95% CI: 35.5-53.0 months) and 44.26 (95% CI: 39.0-57.5 months), P = 0.46.Conclusion:There was a significant reduction in the recurrence rate and time to recurrence with ET. Rate of progression was also relatively less with ET, though not statistically significant.

Could basic research shed light on false positivity in photodynamic diagnosis?

Accumulating evidence has suggested that photodynamic diagnosis (PDD) using new optical imaging agents (5-aminolevlinic acid [5-ALA] or hexaminolevulinate [Hexvix]) has an advantage detecting the flat tumor of the bladder, especially carcinoma in situ, or tiny papillary tumors, which might be overlooked by conventional white-light cystoscopy.1 Recent randomized controlled trials have shown that PDD-assisted transurethral resection of bladder tumors (TURBT) yields better clinical outcomes in terms of progression-free survival than conventional TURBT.2 Most readers might have simple questions about PDD. How does is the red fluorescence imaging generated from cancer tissue? How is the optical imaging agent administered, and accumulated specifically, if true, in the tumor? Are there any adverse effects (AE) including photosensitivity? Intravesically or orally administered 5-ALA is uptaken to cells by active transport and incorporated into mitochondria. As ferrochelatase, a key enzyme of final process of heme synthesis, is inherently absent in tumor cells, an intermediary metabolite (protoporphirin IX [PPIX]) is specifically accumulated in tumor cells. Dysfunction of the transporter gene, which acts as a efflux pump of PPIX in tumor cells, might accelerate the specific accumulation of the agent.3 Regarding AE of 5-ALA, no severe photosensitivity, which is a common and severe AE of the conventional optical imaging photosensitizer, have been reported. As 5-ALA is not approved by Japan, a multi-institutional prospective phase I/II study is in progress as the investigator initiated clinical trial. One of the drawbacks of PDD, however, is a relatively higher false positive rate. Although red fluorescence is theoretically generated only from tumor cells, false positive fluorescence is often encountered in the clinical setting, leading to lowering specificity to 50–60% in the literature. Why does false red fluorescence take place? One of the possible reasons is an optical artifact as a result of tangential observation. Artifact is often observed at the bladder neck and prostatic urethra. Other possibilities have been reported to result from cystitis, squamous metaplasia, mild to moderate dysplasia, or hyperplasia. Can all false positivity be ignored as a non-cancerous phenomenon? It is well known that urothelial tumor is chronologically or spatially multifocal as a result of harboring either a field defect, or dissemination of the clonally-selected cancer cell. Non-random gene alterations have been reported to occur frequently at chromosomes 7, 9 and 17, and those alterations strongly affect patient outcome in bladder cancer. We hypothesized that false positive bladder mucosa might harbor premalignant lesion (Fig. 1).4 Lengauer et al. postulated the concept of chromosomal instability, which is evaluated by a higher aberrant fraction of the copy number, a non-modal fraction of the copy number distribution in each chromosome.5 The aberrant fraction of chromosome 9 by fluorescence in situ hybridization analysis was significantly higher in false positive fluorescent mucosa than that in the non-fluorescent counterpart. Array comparative genomic hybridization using established bladder cancer cell lines showed 9p24.1 to be a commonly deleted region for fluorescent positive cell lines.4 Hartmann et al. reported that the deletion of p53 was highly associated with chromosome 9 alterations in the flat urothelial lesions detected by fluorescent cystoscopy.6 Other investigators reported a close association between chromosome 9 alterations and fluorescent mucosa. A phase III randomized controlled trial proved that PDD-guided transurethral resection, with the resection of all visible fluorescent mucosae, yielded a statistically higher progression-free survival than did conventional transurethral resection.2 The study suggests that an incomplete resection, or ignoring the fluorescent mucosa with PDD except for optical artifacts, might thus leave a potential source for bladder tumor recurrence. Case presentation. 56 years, Male 2003/10/31 First presentation, Pathology: TCC, G2, pTa. 2006/4/26 Recurrence. (a) Representative case of positive of photodynamic diagnosis. Normal looking mucosa by white-light (conventional) cystoscopy. (b) Photodynamic diagnosis showing irregular red fluorescence, (c) Molecular cytogenetic by fluorescence in situ hybridization analysis showing a higher variant fraction of chromosome 9. Arrow: chromosome 9 monosomy. The pathological diagnosis was mild dysplasia. Could basic research shed light on false positivity of PDD? Yes, such false positive mucosa by PDD might be a potential reason for exploring the mechanism of oncogenesis in urothelial cancer. None declared.

Comparison between intravesical and oral administration of 5‐aminolevulinic acid in the clinical benefit of photodynamic diagnosis for nonmuscle invasive bladder cancer

This study was undertaken to evaluate the clinical value of photodynamic diagnosis (PDD) with intravesical and oral instillation of 5-aminolevulinic acid (ALA) (ALA-PDD), and transurethral resection of bladder tumor (TURBT) guided by ALA-PDD (PDD-TURBT) for nonmuscle invasive bladder cancer. Of all 210 cases, 75 underwent PDD with intravesically applied ALA, and 135 cases underwent PDD with orally applied ALA. Diagnostic accuracy was evaluated by comparing the level on images of ALA-induced fluorescence with the pathological result. PDD-TURBT was performed in 99 completely resectable cases corresponding to 210 ALA-PDD cases. To evaluate the abilities of PDD-TURBT, survival analysis regarding intravesical recurrence was retrospectively compared with the historical control cases that underwent conventional TURBT. The diagnostic accuracy and capability of ALA-PDD were significantly superior to those of conventional endoscopic examination. Moreover, 72.1% of flat lesions, including dysplasia and carcinoma in situ, could be detected only by ALA-PDD. The recurrence-free survival rate in the cases that underwent PDD-TURBT was significantly higher than that of conventional TURBT. Moreover, multivariate analysis revealed that the only independent factor contributing to improving prognosis was PDD-TURBT (hazard ratio, 0.578; P = .012). Regardless of the ALA administration route, there was no significant difference in diagnostic accuracy, ability of PDD, or recurrence-free survival. All procedures were well tolerated by all patients without any severe adverse events. This multicenter study is likely to be biased, because it is limited by the retrospective analysis. This study suggests that regardless of the ALA administration route, ALA-PDD and PDD-TURBT are remarkably helpful in detection and intraoperative navigation programs.

光力学診断補助下経尿道的膀胱腫瘍切除術の臨床経験

To report our clinical experience regarding transurethral resection of bladder tumor (TUR-Bt) guided by photodynamic diagnosis (PDD) with intravesical instillations of 5-aminolevulinic acid (ALA) and to assess the usefulness of the therapeutic method. TUR-Bt guided by PDD was performed in 57 patients of which 47 were men and 10 women with a median age of 74.3 years (range 45-90), 36 were primary cases and 21 were recurrent cases with non-muscle invasive bladder cancer. Two to two and half hours prior to endoscopy 1.5 g ALA dissolved in 50 ml of 8.4% sodium hydrogen carbonate (NaHCO3) solution was instilled intravesically. For fluorescence excitation a blue light source (D-LIGHT System, Karl Storz Endoscopy Japan K.K.) was used. The tumorous lesions under white light guidance and the lesion with fluorescent excitation under blue (fluorescence) light guidance were taken by cold cup as a biopsy and also resected sequentially. To evaluate the accuracy of PDD, the levels in images of the ALA-induced fluorescence were compared with the pathological results. To evaluate the availability of TUR-Bt guided by PDD, survival Analysis regarding vesical recurrence was retrospectively examined compared to the cases underwent conventional TUR-Bt under white light guidance. Moreover, in these cases, multivariate analysis using Cox proportional-hazards model was performed to detect the clinico-pathological factor independently contribute to improving prognosis. (Results) In the 301 specimens obtained from 57 patients, the sensitivity and specificity of PDD were 92.5% and 60.1%, whereas the sensitivity and specificity of conventional endoscopic examination under white light guidance were 81.6% and 79.5%, respectively. Median follow-up period was 19.1 (range 8.6-49.9) months in 57 patients underwent TUR-Bt guided by PDD. Eight of 57 patients recurred and recurrence-free survival rate was 88.2 +/- 0.1% (at 12 months) and 76.2 +/- 0.1% (24-48 months). Median follow-up period was 49.9 (5.0-145.0) months in 149 patients underwent conventional TUR-Bt. Ninety-nine of 149 patients recurred and recurrence-free survival rate was 60.3 +/- 0.0% (12 months) and 31.6 +/- 0.0% (24-48 months). There was statistical significance in recurrence-free survival rate between these 2 therapeutic groups (p < 0.001). Moreover, multivariate analysis revealed the independent factor contribute to improving prognosis was only TUR-Bt guided by PDD (hazard ratio 0.279, p = 0.001). It was suggested that TUR-Bt guided by PDD might reduce the risk of vesical recurrence in the early stage after operation of non-muscle invasive bladder cancer.