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Transitional Cell Carcinoma of the Bladder
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
T. R. Leyshon Griffiths, Nick Mayer
The use of white light cystoscopy alone at the time of TUR bladder tumor may miss lesions that are present but not visible. Fluorescence cystoscopy is performed using blue-violet light after intravesical instillation of photosensitizer, usually 5-aminolevulinic acid (5-ALA) or hexaminolevulinate (HAL). 5-ALA fluorescence cystoscopy has been shown to detect more CIS and papillary tumors (75). In a randomized trial, 5-ALA fluorescence cystoscopy at the time of diagnostic TUR bladder tumor was associated with reduced residual disease (76). Of those who underwent fluorescence cystoscopy at initial TUR bladder tumor, 4.5% had residual disease compared with 25% who underwent white light cystoscopy. In the same trial, fluorescence cystoscopy at diagnostic TUR bladder tumor reduced the recurrence rate. Eight years after initial TUR bladder tumor, 29% of those who underwent 5-ALA fluorescence cystoscopy developed a recurrence compared with 55% in the white light cystoscopy arm. HAL fluorescence cystoscopy has also been shown to improve the detection of CIS and papillary tumors.
Endoscopy
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Musaab Sarmad Yassin, John Michael Henderson, Francis Xavier Keeley
Cystodistension Allows the clAssificAtion of bPs According to the InternAtionAl society for the study of InterstitiAl Cystitis clAssificAtion, depending on the cystoscopic findings of glomerulAtions (Figure 39.6) or Hunner's ulcer, in Addition to certAin histologicAl findings on biopsy. once Access to the blAdder hAs been obtAined, the upper trActs mAy be Accessed viA the ureteric orifices. retrogrAde injection of contrAst under rAdiogrAphic screening Allows definition of the upper trAct AnAtomy, including filling defects cAused by tumors or cAlculi. These AbnormAlities mAy be treAted with lAser lithotripsy. self-retAining double-pigtAil stents (Figure 39.7) cAn be inserted into the ureter. This mAy be done prophylActicAlly to Aid in identificAtion of the ureter intrAoperAtively or to relieve obstruction or treAt ureteric injury. The technologicAl developments in the field of endoscopy hAve led to improved imAge quality with smAller, more mAneuverAble instruments. refinements in opticAl technology hAve fAcilitAted improvements in identificAtion of AbnormAl tissue. nArrowbAnd imAging refers to the use of light in the blue (415 nm) And green (540 nm) spectrum thAt Are strongly Absorbed by hemoglobin. This enhAnces the contrAst between normAl urothelium And hypervAsculAr mAlignAnt tissue. The surfAce cApillAries AppeAr brown And the deeper veins cyAn. Fluorescence cystoscopy involves the AdministrAtion of A photoActive porphyrin, e.g., hexAminolevulinAte (HAL) or 5-Aminolevulinic Acid (ALA) 1 hour before cystoscopy. These porphyrins preferentiAlly AccumulAte in mAlignAnt tissue And AppeAr red under blue light (of wAvelength 380–450 nm). There is some evidence thAt the use of fluorescence cystoscopy improves cAncer detection rAtes And reduces recurrence [4]. The limitAtion on imAge quality of A normAl cystoscope is the interfAce between the eyepiece And the cAmerA. DigitAl endoscopes (Figure 39.8) rely on A chArge-coupled device on the tip of the endoscope ("chip-on-the-tip"). The projection
The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem
Published in Scandinavian Journal of Urology, 2021
Marie Andersson, Marthe Berger, Karsten Zieger, Per-Uno Malmström, Mats Bläckberg
The use of photodynamic diagnosis (PDD) in conjunction with TURB is now widespread. Flat lesions, that is, CIS and small papillary lesions may be difficult to detect with WLFC. Instead of ‘blind mapping’ the biopsies can be taken under the guidance of PDD after a porphyrin-derived photosensitizer, hexaminolevulinate (HAL), is instilled into the bladder. HAL accumulates in highly proliferating tumour cells and emits red light upon blue light excitation [13]. Studies have shown that TURB with PDD is more sensitive than conventional TURB for the detection of malignant tumours of the bladder, especially CIS [14,15]. The use of PDD may also reduce residual tumour rates and increase recurrence-free survival [16,17]. According to previous studies, blue-light flexible cystoscopy (BLFC) in the outpatient setting with on-site biopsy and fulguration appears to be feasible, and allows early detection of recurrent lesions [18–21].
Outpatient diode laser treatment of intermediate-risk non-invasive bladder tumors without sedation: efficacy, safety and economic analysis
Published in Scandinavian Journal of Urology, 2018
Gregers Gautier Hermann, Karin Mogensen, Susanne Rosthøj
For LDB, 50 ml hexaminolevulinate (Hexvix; Photocure, Oslo, Norway) and 20 ml lidocaine anesthetic (20 mg/ml) were instilled into the bladder through a LoFric catheter Ch 12 (Astra Tech, Mölndal, Sweden). Ibuprofen 600 mg and acetaminophen 1 g were also offered as oral pain treatment. One hour later, LDB was performed using a flexible videocystoscope (11272 VPI, D-LIGHT C-LIGHT source; Karl Storz, Tuttlingen, Germany). The bladder was first inspected in white light while the urine was replaced with sterile water by irrigation of the bladder twice through the cystoscope, as urine hinders visualization during PDD by releasing green autofluorescence when illuminated by blue light [7]. Then, the illumination light was switched from white to blue light and PDD was performed as blue-light cystoscopy. The locations of tumors observed in each modality were recorded on a bladder map so that laser-treated areas could be biopsied 1 month later for assessing tumor clearance after LDB.
Emerging roles of autophagy in the development and treatment of urothelial carcinoma of the bladder
Published in Expert Opinion on Therapeutic Targets, 2021
Pratishtha Gupta, Niraj Kumar, Minal Garg
Photodynamic therapy is considered as a new and emerging modality for treatment of bladder cancer patients who experience BCG failure. This therapy uses photosensitizing agents, such as 5-aminolevulinic acid, hexaminolevulinate (HAL), or radachlorin. These agents upon administration get activated by light at the appropriate wavelength. Electron microscopic studies on rat xenograft models examine autophagic induction as evidenced by the increased appearance of vacuoles and lipofuscin bodies in the cytoplasm following the photodynamic therapy [62]. Future studies are required to check the efficacy of combinational treatment of bladder cancer patients with photosensitizing agents in conjunction with autophagic inhibitors.