Photodynamic Diagnosis in Urology: State-of-the-Art

Feasibility of Photodynamic Diagnosis for Challenging TUR-Bt Cases Including Muscle Invasive Bladder Cancer, BCG Failure or 2nd-TUR

“…Sensitivity and specificity of WLC and PDD are 46%-80% and 76-97%, and 43%-98% and 35-66%, respectively. (Zaak and Hofstetter, 2002;Grimbergen et al, 2003;Jichlinski et al, 2003;Schmidbauer et al, 2004;Fradet et al, 2007;Grossman et al, 2007;Jocham et al, 2008;Stenzl et al, 2008;Geavlete et al, 2012) Now PDD is emerging to diagnose NMIBC or carcinoma in situ. However no studies specifically used PDD for muscle invasive bladder cancer, cystoscopic observation for BCG failure cases or 2nd-TUR cases.…”

Bladder cancer in cystoscopically normal‐appearing mucosa: a case of mistaken identity?

“…The 2004 consensus classification states that flat lesions with minimal cytological atypia should be diagnosed as 'normal', and dysplasia, defined as a flat lesion of the urothelium with appreciable cytological and architectural abnormalities, falls short of the diagnostic threshold for CIS [17,18]. However, such details might be difficult to differentiate, and the fact that there is interobserver variability, and that not all series used referee pathologists, suggests that, despite standard pathological criteria defining CIS, not all A fourth explanation is that normal mucosa might contain endogenous porphyrin that could be highlighted by fluorescence cystoscopy [11]. However, even if blue-light had indicated any tumour in our biopsy sites does not negate the fact that the mucosa had no evidence of carcinoma.…”

“…The frequency of 'missed lesions' found in biopsies of normalappearing bladder mucosa is 8-41% [2][3][4][5][6][7], and new imaging methods, such as fluorescent or 'blue-light' cystoscopy, identify tumours not seen on WLC in 9-35% of patients [8][9][10]. Finding carcinoma in situ (CIS) undetected on WLC better defines the extent of disease, might lead to changes in treatment with improved outcomes [11], and is a primary reason driving the current generation of new optical diagnostics for bladder cancer [12].…”

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

“…Protoporphyrin IX fluoresces red under blue light, thereby allowing abnormal cells to be more easily identified by the surgeon. 6 We explored the use of blue light cystoscopic treatment of patients in whom intravesical immunotherapy and chemotherapy was contraindicated or unsuccessful and in whom radical cystectomy was not an option. Our experience highlights the potential complication of bladder contracture with repeated cystodiathermy, and suggests that the role of blue light cystoscopy in long-term follow-up and treatment of CIS with cystodiathermy is not without problems.…”