title: A network meta-analysis of therapeutic outcomes after new image technology-assisted transurethral resection for non-muscle invasive bladder cancer: 5-aminolaevulinic acid fluorescence vs hexylaminolevulinate fluorescence vs narrow band imaging.
abstract: BACKGROUND
  This study included a network meta-analysis of evidence from randomized controlled trials (RCTs) to assess the therapeutic outcome of transurethral resection (TUR) in patients with non-muscle-invasive bladder cancer assisted by photodynamic diagnosis (PDD) employing 5-aminolaevulinic acid (5-ALA) or hexylaminolevulinate (HAL) or by narrow band imaging (NBI).
  
  
  METHODS
  Relevant RCTs were identified from electronic databases. The proceedings of relevant congresses were also searched. Fifteen articles based on RCTs were included in the analysis, and the comparisons were made by qualitative and quantitative syntheses using pairwise and network meta-analyses.
  
  
  RESULTS
  Seven of 15 RCTs were at moderate risk of bias for all quality criteria and two studies were classified as having a high risk of bias. The recurrence rate of cancers resected with 5-ALA-based PDD was lower than of those resected using HAL-based PDD (odds ratio (OR) = 0.48, 95 % confidence interval (CI) [0.26-0.95]) but was not significantly different than those resected with NBI (OR = 0.53, 95 % CI [0.26-1.09]). The recurrence rate of cancers resected using HAL-based PDD versus NBI did not significantly differ (OR = 1.11, 95 % CI [0.55-2.1]). All cancers resected using 5-ALA-based PDD, HAL-based PDD, or NBI recurred at a lower rate than those resected using white light cystoscopy (WLC). No difference in progression rate was observed between cancers resected by all methods investigated.
  
  
  CONCLUSIONS
  The recurrence rate of some bladder cancers can be decreased by the implementation of either PDD- and NBI-assisted TUR; in real settings, clinicians should consider replacing WLC as the standard imaging technology to guide TUR.
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. joouro@yuhs.ac.
authors.forename: Joo Yong
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. kscho99@yuhs.ac.
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
authors.affiliation: Department of Urology, Yangpyeong Health Center, Yangpyeong, Korea. doudong14@gmail.com.
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. urooru@yuhs.ac.
authors.forename: Hae Do
authors.initials: HD
authors.lastname: Jung
authors.affiliation: Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. jkstorm@naver.com.
authors.forename: Jong Kyou
authors.initials: JK
authors.lastname: Kwon
authors.affiliation: Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. ckohuro@gmail.com.
authors.forename: Cheol Kyu
authors.initials: CK
authors.lastname: Oh
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. uroham@yuhs.ac.
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Ham
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. youngd74@yuhs.ac.|Department of Urology, Clinical Trial Center for Medical Devices, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. youngd74@yuhs.ac.
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives* / Q000378:metabolism*; D003558:Cystoscopy / Q000379:methods; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D062048:Narrow Band Imaging / Q000379:methods; D017319:Photosensitizing Agents / Q000378:metabolism*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester