[Is a routine second transurethral resection of the bladder still necessary after hexaminolévulinate photodynamic diagnosis-assisted TURBT?]

Abstract

OBJECTIVES:

The aim of our study was to assess the impact of blue light cystoscopy with hexaminolevulinate on residual tumor rates at second-look transurethral resection of the bladder (TURB).

MATERIAL AND METHODS:

Among all patients undergoing TURB in our center between 2012 and 2017, 52 patients had a second-look after a first complete TURB with a delay<3months. We compare patients with standard white light cystoscopy/TURB then second-look blue light cystoscopy/re-TURB (group A, n=30) and patients with blue light cystoscopy/TURB at the initial procedure then white light cystoscopy/re-TURB (group B, n=22). The residual tumor rates at second-look, restaging and changing in therapeutic strategy, as well as recurrence free survival and progression rate were compared.

RESULTS:

Residual tumor at the time of second-look cystoscopy was detected in 42.3% of cases in our cohort, with a significant difference between the two groups (63.3% in group A versus 0% in group B, <0.001). In group A, 16.7% (5/30) of patients had upstaging and/or upgrading at second-look cystoscopy, resulting in a change in therapeutic strategy in most cases (4/5) while none upstaging was observed in group B. In multivariate analysis, the use of luminofluorescence at the first TURB was the only independent predictive factor of residual tumor (P=0.0031).

CONCLUSION:

The quality of the initial TURB, when performed by using blue light cystoscopy, had a significant impact on the rate of residual tumor at the second-look resection and could modify therapeutic strategy of NMIBC.

LEVEL OF EVIDENCE:

4.

• Authors: L Doisy, J Walz, S Fakhfakh, S Rybikowski, Y Koskas, G Gravis, G Pignot
• Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie (Prog Urol) 2019 May - Jun Vol. 29 Issue 6 Pg. 332-339 ISSN: 1166-7087 [Print] France
• Vernacular Title: La résection transurétrale de vessie de réévaluation est-elle toujours nécessaire en cas de primo-résection sous luminofluorescence par hexaminolévulinate ?
• PMID: 31104952 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Masson SAS. All rights reserved.

Chemical References

• Aminolevulinic Acid
• 5-aminolevulinic acid hexyl ester

Topics

• Aged
• Aged, 80 and over
• Aminolevulinic Acid (analogs & derivatives, therapeutic use)
• Cystectomy (methods)
• Female
• Humans
• Male
• Middle Aged
• Optical Imaging
• Retrospective Studies
• Second-Look Surgery
• Surgery, Computer-Assisted
• Urinary Bladder Neoplasms (diagnostic imaging, surgery)