title: The quality of 5-aminolevulinic acid-induced photodynamic diagnosis and transurethral resection of bladder tumors: does the urologist play a role?.
abstract: BACKGROUND
  The aim of this study is to evaluate the quality of photodynamic diagnosis (PDD) and transurethral resection of bladder tumors (TURBT) among different urologists.
  
  
  METHODS
  The selected data consists of 194 patients, 268 5-aminolevulinic acid (5-ALA)-induced PDD procedures and 934 biopsies. Tumors were resected and biopsies were taken from suspicious areas under guidance of white light endoscopy and 5-ALA-induced fluorescence cystoscopy. The quality of PDD was determined by evaluating the mean number of tumors resected by 5 urologists and, thereafter, assessing the time to recurrence between groups.
  
  
  RESULTS
  Urologist 1 took 37% more biopsies (p < 0.001) and diagnosed 42% more tumors (p = 0.005) and 46% more false positives (p < 0.001) from bladders compared to urologists 2, 3, 4 and 5 together. The mean time to bladder cancer recurrence for all recurrences within 0-18 months was 11.0 months for operator 1 and 8.3 months for the other urologists (p = 0.01).
  
  
  CONCLUSIONS
  The resecting urologist appears to be an important factor for the quality of standard and PDD-assisted TURBT. Learning curve programs may be required with experienced surgeons accompanying those with less experience.
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. r.draga@umcutrecht.nl
authors.forename: Ronald O P
authors.initials: RO
authors.lastname: Draga
authors.forename: Matthijs C M
authors.initials: MC
authors.lastname: Grimbergen
authors.forename: Esther T
authors.initials: ET
authors.lastname: Kok
authors.forename: Trudy N
authors.initials: TN
authors.lastname: Jonges
authors.forename: Christiaan F P
authors.initials: CF
authors.lastname: van Swol
authors.forename: Ruud J L H
authors.initials: RJ
authors.lastname: Bosch
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000494:pharmacology*; D001706:Biopsy / Q000379:methods; D003558:Cystoscopy / Q000379:methods; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D012008:Recurrence; D015203:Reproducibility of Results; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery* / Q000628:therapy*; D014572:Urology / Q000379:methods*
chemical_list: D000622:Aminolevulinic Acid