Complication of treatment of carcinoma in situ of the bladder with photodynamic targeted cystodiathermy

Abstract

We report two cases of bladder contracture following photodynamic or 'blue light' detection and cystodiathermy for bladder carcinoma in situ. These patients were unsuitable for treatment with immunotherapy/chemotherapy or had disease recurrence following such treatment. Radical cystectomy was not a treatment option in either patient. Each underwent serial photodynamic cystodiathermy over a three-year period. Neither patient developed muscle invasive disease. However, treatment resulted in contracture of the bladder and incontinence of urine. Patients need to be fully aware of this potential complication in order to make informed choices about their care. Case 1This patient was a 75-year-old man with frank haematuria who was found to have a diagnosis of carcinoma in situ (CIS) on biopsy following suspicious urine cytology. Relevant medical history included idiopathic thrombocytopenia purpura, a prior splenectomy, three previous deep vein thromboses, and an unspecified vasculitis requiring immunosuppression with azathioprine and prednisolone. Intravesical bacillus Calmette-Guérin (BCG) or mitomycin therapies were contraindicated owing to his immunosuppressed status and history of thrombocytopenia. His premorbid state deemed him an unsuitable candidate for a radical cystectomy. Following initial resection, he underwent blue light guided cystodiathermy ablation of fluorescent areas on a six-monthly basis. Between