C120 Recurrence rates in high-risk non-muscle invasive bladder tumors – the real impact of HAL blue light fluorescence cystoscopy and TURB

Objective: The aim of this study was to assess the quality of TURBT (transurethral resection of bladder tumor) using surrogate parameters and evaluate adherence to the guidelines regarding the management of bladder tumors. Materials and methods: A clinical audit of all new diagnosis of bladder cancer was undertaken from January 2016 to January 2017. A total of 101 new bladder cancer cases were included. Surrogates of TURBT quality including presence of detrusor in the specimen, rate of re-TUR, presence of carcinoma in situ, and 3-month recurrence rates were analyzed. Adherence to guidelines regarding management of non-muscle invasive bladder cancer including time to re-TUR and utilization of single instillation chemotherapy was evaluated. Results: Absence of detrusor muscle in the specimen of the initial TURBT was noted in 22.8% of the cases. The chance of including muscle in the specimen was almost four-fold for tumors larger than 3 cm. A single instillation of intravesical chemotherapy following TURBT was administered in only 40% of eligible patients; 54.3% of patients had a re-TUR, the majority (61.3%) for high-grade non-muscle invasive bladder cancer on initial TURBT. Re-TUR was done on average 10 weeks after initial TURBT. The 3-month recurrence rate was 36.0% with larger tumors (>3 cm) being more prone to early recurrences. Early recurrences were not affected by intravesical instillations with bacillus Calmette–Guérin or mitomycin C although there was a positive association between the presence of carcinoma in situ on initial resection and early recurrences. Discussion and conclusion: One in two patients will have a re-TUR, and approximately one in two patients will have tumor on re-TUR. Single immediate chemotherapy instillations after TURBT are underutilized. The presence of carcinoma in situ on initial TURBT and tumor size were predictors of early recurrences.

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Value of Fluorescence Cystoscopy in High Risk Non-muscle Invasive Bladder Cancer

Current Urology Reports ◽

10.1007/s11934-013-0306-0 ◽

2013 ◽

Vol 14 (2) ◽

pp. 90-93 ◽

Cited By ~ 2

Author(s):

Roman Mayr ◽

Maximilian Burger

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Fluorescence Cystoscopy ◽

Muscle Invasive

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Incidence and Predictors of Secondary Upper Tract Urothelial Cancer in Patients with High-Risk Non-Muscle Invasive Urinary Bladder Cancer and its Impact on Imaging Surveillance: A Retrospective Analysis with 1501 Patients

Société Internationale d’Urologie Journal ◽

10.48083/nztc6259 ◽

2021 ◽

Vol 2 (3) ◽

pp. 151-157

Author(s):

Ebrahim Elsaeed Abouelenein ◽

Mohamed Elawdy ◽

Diaa-Eldin Taha ◽

Yasser Osman ◽

Bedeir Ali-El Dein ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Urothelial Cancer ◽

Multivariable Analysis ◽

Bladder Tumors ◽

Upper Tract ◽

Upper Tract Urothelial Cancer ◽

Imaging Surveillance ◽

Muscle Invasive

Objectives: We aimed to study the incidence and predictors of upper tract urothelial cancer (UTUC) in patients with high-risk non-muscle invasive bladder cancer (HR-NMIBC). Methods: Patients who had HR-NMIBC were reviewed to identify those who subsequently developed UTUC. Complete transurethral resection was performed, and biopsies were collected for histopathology followed by intravesical chemoimmunotherapy. Patients were screened annually by computed tomography (CT) for UTUC. Results: Data for 1501 patients were reviewed. UTUC developed in 59 (4%) after a median of 20 months after HR-NMIBC. Most patients were symptomatic, but UTUC was discovered on routine follow-up imaging in 28%. On bivariate analysis, only multiple bladder tumors and the number of bladder recurrences were predictors for UTUC (P = 0.01 and P = 0.008, respectively). Multiple bladder tumors and ≥ 3 bladder recurrences remained significant on multivariable analysis. Conclusion: UTUC after HR-NMIBC is uncommon (4%). Despite routine follow-up CT imaging, recurrence was detected due to symptoms in most patients, and based on imaging only in 28%. Imaging surveillance can be prioritized in patients with multiple bladder tumors and those with ≥ 3 bladder recurrences. For the other patients, the benefit of imaging surveillance has to be weighed against the risks.

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Blue light cystoscopy with hexylaminolevulinate: Our 7 years experience

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.1.39 ◽

2017 ◽

Vol 89 (1) ◽

pp. 39

Author(s):

Vito Lacetera ◽

Ubaldo Cantoro ◽

Lorenzo Montesi ◽

Daniele Cantoro ◽

Bernardo Cervelli ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Blue Light ◽

Daily Practice ◽

High Grade ◽

White Light Cystoscopy ◽

Risk Patients ◽

History Of ◽

Muscle Invasive ◽

Or History

Aim: The objective of the present study is to evaluate the diagnostic accuracy of hexylaminolevulinate (HAL) blue light cystoscopy compared with standard white light cystoscopy (WLC) in daily practice. Materials and methods: An observational, comparative, controlled (within patient) study was carried out at our Center. 61 consecutive patients with suspected or confirmed bladder cancer were recruited for the study from January 2008 until January 2015. Patients with suspected bladder cancer (positive cytology with negative WLC) or history of previous high-grade NMIBC or CIS were included in the study. Biopsies/resection of each positive lesion/suspicious areas were always taken after the bladder was inspected under WLC and BLC. Diagnoses of bladder tumor or CIS were considered as positive results, and the presence of normal urothelium in the biopsy specimen as negative result. Results: 61 BLC were performed. 15/61 (24.5%) with suspected initial diagnosis of NMIBC and 46/61 (75.5%) with a history of high-risk non-muscle invasive bladder cancer (NMIBC). We performed a total of 173 biopsies/TURBT of suspicious areas: 129 positive only to the BLC and 44 both positive to WLC and BLC. 84/173 biopsies/TURBT were positive for cancer. All 84 NMIBC were positive to the BLC, while 35/84 were positive to the WLC with a sensitivity of BLC and WLC respectively of 100% and 41.7%. Sensitivity of WLC for highgrade NMIBC and CIS was 34.1% and 39% respectively while sensitivity of BLC for high-grade NMIBC and CIS was 100%. The specificity of the WLC was 79.9% compared to 48.5% of the BLC. The positive predictive value of BLC and WLC were respectively 48% (95% CI: 0.447-0.523) and 79% (95% CI: 0.856-0.734). Conclusions: Our data confirm those reported in the literature: BLC increases the detection rate of NMIBC particularly in high risk patients (history of CIS or high grade). BLC is a powerful diagnostic tool in the diagnosis of bladder cancer if malignancy is suspected (positive urine cytology) and if conventional WLC is negative.

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