Photodynamic diagnosis of superficial urinary bladder tumours - own experience
Article published in Urologia Polska 2004/57/3.

authors

Marek Lipiński

Klinika Urologii z Pracownią Litotrypsji Uniwersytetu Medycznego w Łodzi
Kierownik kliniki: prof. dr hab. Leszek Jeromin

keywords

urinary bladder, superficial tumour, photodynamic diagnostic method

summary

introduction

Photodynamic diagnosis (PDD) of tumours is the most precise method of imaging the neoplasmatic tissue.

aim of the publication

The aim of the publication is to determine its value in the diagnosis of superficial tumours of the urinary bladder and its usefulness in estimating the radicality of TURP.

material and methods

427 photodynamic diagnostic session were performed from December 1996 to December 2002 in 115 patients (28 F, 87 M) with the histologically confirmed recurrent tumours of the bladder. PDD was applied once in 17 patients, twice in 21, three or more times (from 3 to 7) - in 77 patients. In 97 patients PDD was performed after tumour removal by TURP in white light (TURBT). Before PDD as well as after its application and therapy the patients were under follow-up for 18 months.

results

In 75 out of 115 patients white-light cystoscopy did not disclose neoplasmatic lesions. Comparing images of white-light (SB) and ultraviolet (UV) cystoscopy failed to prove such lesions in 21 (18,3%) patients. In 54 patients SB did not indicate to neplasm, while UV revealed local fluorescence and biopsy confirmed the presence of tumour. Lesions Tis were found by UV in 22 patients. Ta (G1 and G2) were confirmed in 37 patients, in 6 of them by SB and in additional 31 - by UV. T1 changes were confirmed by UV in 32 patients, while by SB - in 32 patients. In 3 patients T2 changes were found both by SB and UV. Incidence of recurrences after electrocoagulation or TURBT was analyzed for the period before and after application of PDD as the method of following neoplasmatic changes during TURBT. When the radicality of TURBT was not checked by PDD, recurrence after 12 months followed in 48 patients, while PDD-checked TURBT led to recurrence in 21 patients.

conclusions

1. Ultraviolet cystoscopy (photodynamic diagnosis - PDD) is more sensitive than standard white-light cystoscopy in diagnosing superficial tumours of the urinary bladder.

2. Cystoscopy as the method of diagnosing superficial tumours of the urinary bladder and their early recurrence or new focuses is less satisfactory if not supported by PD.

3. PD helps to determine the radicality of transurethral electroresection of the urinary bladder superficial tumours.

4. Introducing the photodynamic diagnosis in the public health system would diminish percentage of recurrences and improve the final results of therapy.