Adult urologySeven Years’ Experience with 5-Aminolevulinic Acid in Detection of Transitional Cell Carcinoma of the Bladder
Section snippets
Patients
From February 1995 to February 2002, 1713 PDD procedures were performed in 875 patients (204 women and 671 men, age range 16 to 99 years, average age 65.3). Of the 875 patients, 327 were treated for primary bladder cancer and 548 were under surveillance because of previous transitional cell carcinoma of the urinary bladder. The patients with a history of recurrent disease had undergone multiple TURs (range 1 to 22, average 3.6). All patients provided written informed consent.
5-ALA Administration
We instilled 1.5 g
Results
In total, 1713 fluorescence endoscopy procedures were performed in 875 patients. Biopsies from 4630 lesions were obtained. The mean biopsy rate was 2.7 per endoscopy. Papillary tumors, as well as flat urothelial lesions, developed a bright red fluorescence. In contrast, the adjacent normal urothelium appeared blue. For 139 fluorescence endoscopy procedures, the WLE and fluorescence findings were negative.
No patients had any side effects from intravesical application of 5-ALA; in particular, no
Comment
The current diagnostic and therapeutic approaches for bladder cancer seem to be inadequate in many respects.4, 8 The present data, which to our knowledge contain the greatest number of fluorescence endoscopic procedures published to date, support the finding that PDD is highly effective in the identification of transitional cell carcinoma of the bladder compared with WLE alone. Previously, various studies performed by different investigators demonstrated the diagnostic value of PDD, with a
Conclusions
Seven years after the introduction of 5-ALA-induced fluorescence endoscopy in the detection of bladder cancer, PDD has become an established procedure in daily routine use. The detection rate for all tumor lesions, and in particular for flat lesions, has been markedly improved compared with WLE. Furthermore, recent data have shown a significant reduction in residual tumor after TUR, and PDD has been proved to reduce the recurrence rate in patients with transitional cell carcinoma of the
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This study was supported by grants from the Deutsche Forschungsgemeinschaft (DFG Kr1645/1-1).