Photodynamic diagnosis (PDD) in transurethral bladder tumour therapy – up to date results of 244 histological proven specimens
Ch. Lang, Y. AlBulushi, Sch. Alloussi
Department Of Urology, Staedtisches Klinikum Neunkirchen, Academic Teaching Hospital of Saarland University
White light Cystoscopy (WL) and TUR of superficial bladder tumours are the standard methods for the diagnosis and therapy of non muscle-invasive transitional cell carcinoma (TCC) of the bladder. Flat tumours and Carcinoma in situ (pTis) can be easily overlooked.
According to EAU guidelines, PDD with Hexyl Aminolevulinic Acid (HAL) can increase the detection of bladder tumours.
Materials and Methods:
From the period of 03/2010-09/2010, 76 Patients, who were indicated for TUR-Bladder, were installed with HAL 1 hour before intervention; the bladder was inspected with WL and PDD. All findings were documented photographically and histological validated. In cases of malignancy, a repeated TUR-Bladder was carried out with WL and PDD after 4 weeks.
A total of 244 specimens were followed up. Histological, 80 cases proven to be TCC,14 cases pTis, 107 cases inflammatory changes, 41 cases Dysplasia, 2 cases Prostate Cancer.
With PDD, 89 histological proven malignancy cases were detected (WL: 67). 124 cases were PDD positive but found to be not malignant (WL: 101). 24 cases were both PDD negative and not malignant (WL: 47). With PDD, 7 cases of malignant tumours were not detected due to no intake of HAL in a bladder diverticulum, underlying ureter ostium tumour and in 2 patients without PDD effect because of short time installation and catheterisation failure).
29 cases of malignant tumours were only with PDD detected.
By the repeated TUR-Bladder, there were 7 cases of tumour recurrence.
PDD is a reliable tool to have a better detection of bladder malignant tumours.
With PDD, the recurrence rate of Bladder tumours can be reduced.
In comparison with the use of PDD, the necessity and meaningful of random Bladder biopsy should be re-evaluated.
The use of PDD is simple; however, qualified Personnel, financial support and technical equipment are important.