title: Photodynamic diagnosis of non-muscle invasive bladder cancer using hexaminolevulinic acid.
abstract: Bladder cancer (BC) is the most common tumor of the urinary tract. White light cystoscopy (WLC) is currently considered the standard investigation for diagnosis of bladder tumors. Recent studies suggest that using exogenous fluorescence (photodynamic diagnosis, PDD) can improve its diagnostic sensitivity and specificity.
  
  
  OBJECTIVE
  Our study aims to analyze the value of using fluorescent cystoscopy (PDD) in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC).
  
  
  METHODS
  The study designed as a prospective randomized clinical trial was conducted over a 12 months period and included 44 patients with primitive NMIBC diagnosed and treated in our department in 2009. Twenty-two patients were included in the study group (PDD), while 22 patients were diagnosed and treated by conventional methods (WLC).
  
  
  RESULTS
  There were no statistically significant differences between the two groups regarding age, sex, place of origin, smoking history, clinical symptoms or presence of urological history as well as tumor size, location or number. Fluorescence cystoscopy examination identified 25.8% more tumors than the conventional examination (p=0.004). We demonstrated a significant reduction of tumor recurrence rates at 3, 6, 9 and 12 months by using PDD (HR=0.3271, 95% CI 0.1091-0.9809; p=0.0461).
  
  
  CONCLUSIONS
  The use of PDD in patients with NMIBC results in significant improvement of the efficiency of their initial diagnosis cystoscopy (by over 25%). We demonstrated improved patient prognosis and quality of life following conservative TUR treatment of these tumors by significantly reducing the tumor recurrence rate (by 9-27%) in the first year of follow-up.
authors.affiliation: Department of Urology, Emergency County Hospital of Craiova, Romania. pdragoescu@yahoo.com
authors.forename: O
authors.initials: O
authors.lastname: Drăgoescu
authors.forename: P
authors.initials: P
authors.lastname: Tomescu
authors.forename: A
authors.initials: A
authors.lastname: Pănuş
authors.forename: M
authors.initials: M
authors.lastname: Enache
authors.forename: C
authors.initials: C
authors.lastname: Maria
authors.forename: L
authors.initials: L
authors.lastname: Stoica
authors.forename: I E
authors.initials: IE
authors.lastname: Pleşea
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D003558:Cystoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008027:Light; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology*; D009361:Neoplasm Invasiveness; D012008:Recurrence; D016037:Single-Blind Method; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology*
chemical_list: D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester