https://doi.org/10.4081/aiua.2022.4.424

Could we safely omit a Repeat Transurethral Resection of the Bladder (re-TURB) after Hexaminolevulinate Photodynamic Diagnostics (PDD)-TURB?

Vol. 94 No. 4 (2022)
Submitted: October 9, 2022
Accepted: November 19, 2022
Published: December 27, 2022
Bladder cancer, Hexvix, TURB, Second resection, Residual tumor
Abstract Views: 661
PDF: 353
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Authors

Vito Lorusso
Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France; Department of Urology, ASST Fatebenefratelli-Sacco Hospital, Milan, Italy; University of Milan, Italy.
Laure Doisy
Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France.
Antonio Maria Granata
Department of Urology, ASST Fatebenefratelli-Sacco Hospital, Milan, Italy.
Andrea Gregori
Department of Urology, ASST Fatebenefratelli-Sacco Hospital, Milan, Italy.
Celeste Manfredi
Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Lorenzo Spirito
Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Carmine Sciorio
Department of Urology, ASST Lecco, Ospedale Alessandro Manzoni, Lecco, Italy.
Luca Giuseppe Maria Ciancimino
Department of Urology, ASST Lecco, Ospedale Alessandro Manzoni, Lecco, Italy.
Samuele Molteni
Department of Urology, ASST Lecco, Ospedale Alessandro Manzoni, Lecco, Italy.
Michele Morelli
Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Luigi Cirillo
Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
Luigi Napolitano
dr.luiginapolitano@gmail.com
Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
Jochen Walz
Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France.
Geraldine Pignot
Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, Italy.

Objective: Bladder cancer (BC) is considered one of the malignancies with moderate-high incidence, high rate of recurrence and costly management. Diagnosis and staging are thus important for therapeutic purposes. Considering the risk of residual tumour and understaging, in specific cases, international guidelines recommend performing a second transurethral resection of the bladder (reTURB). Our study aimed to evaluate the impact of hexaminolevulinate Photodynamic Diagnostics (PDD) at first TURB on the rate of residual tumour.
Materials and Methods: We retrospectively analysed patients undergoing TURB in our centre between 2012 and 2020. Eightytwo patients had a re-TURB after a first complete TURB with a delay < 3 months. Patients who had an incomplete first resection were excluded. We compared patients who underwent standard white light cystoscopy/TURB and then hexaminolevulinate PDDguided reTURB (group A, n = 49) and patients with PDD-cystoscopy/ TURB at the first procedure then white light cystoscopy/reTURB (group B, n = 33). The residual tumour rate at reTURB as well as median recurrence-free survival (RFS) were compared between the two groups.
Results: Residual tumour at reTURB was detected in 48.8% of cases in our cohort, with a significant difference between the two groups (71.4% in group A versus 12.5% in group B, p < 0.001). After a median follow-up of 22 months, the median RFS was 15 months in Group A and 32 months in Group B, but this difference was not significant (p = 0.7).
Conclusions: Using PDD at the time of the initial TURB had a statistically significant impact on the rate of residual tumour at the reTURB. Nevertheless, the percentage of residual tumour even with the use of PDD does not allow for safely omitting second resection. Performing a reTURB with PDD for patients who did not have it initially, provides the same benefit in terms of recurrence-free survival.

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Crossref
Scopus
Google Scholar
Europe PMC
Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, Dominguez Escrig JL, et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1, and Carcinoma in Situ). Eur Urol. 2022 Jan;81(1):75–94.
Sievert KD, Amend B, Nagele U, Schilling D, Bedke J, Horstmann M, et al. Economic aspects of bladder cancer: what are the benefits and costs? World J Urol. 2009 Jun;27(3):295–300.
Napolitano L, Barone B, Reccia P, De Luca L, Morra S, Turco C, et al. Preoperative monocyte-to-lymphocyte ratio as a potential predictor of bladder cancer. J Basic Clin Physiol Pharmacol. 2022 Aug 22;
Creta M, Celentano G, Napolitano L, La Rocca R, Capece M, Califano G, et al. Inhibition of Androgen Signalling Improves the Outcomes of Therapies for Bladder Cancer: Results from a Systematic Review of Preclinical and Clinical Evidence and Meta-Analysis of Clinical Studies. Diagn Basel Switz. 2021 Feb 20;11(2):351.
Manfredi C, Spirito L, Calace FP, Balsamo R, Terribile M, Stizzo M, et al. Oral Preparation of Hyaluronic Acid, Chondroitin Sulfate, Curcumin, and Quercetin (Ialuril® Soft Gels) for the Prevention of LUTS after Intravesical Chemotherapy. Pathophysiol Off J Int Soc Pathophysiol. 2022 Jul 13;29(3):365–73.
Longo N, Celentano G, Napolitano L, La Rocca R, Capece M, Califano G, et al. Metastasis-Directed Radiation Therapy with Consolidative Intent for Oligometastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Cancers. 2022 May 11;14(10):2373.
Ferro M, Del Giudice F, Carrieri G, Busetto GM, Cormio L, Hurle R, et al. The Impact of SARS-CoV-2 Pandemic on Time to Primary, Secondary Resection and Adjuvant Intravesical Therapy in Patients with High-Risk Non-Muscle Invasive Bladder Cancer: A Retrospective Multi-Institutional Cohort Analysis. Cancers. 2021 Oct 21;13(21):5276.
Imperatore V, Creta M, Di Meo S, Buonopane R, Longo N, Fusco F, et al. Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2018 Mar 31;90(1):11–4.
Morelli M, Baboudjian M, Vanacore D, Gondran-Tellier B, McManus R, Karsenty G, et al. Early Photodynamic Diagnosis Cystoscopy After Bacillus Calmette-Guérin (BCG) Induction for High-Risk Nonmuscle Invasive Bladder Cancer Significantly Increased the Detection of BCG Refractory Tumors. J Endourol. 2021 Dec;35(12):1824–8.
Kausch I, Sommerauer M, Montorsi F, Stenzl A, Jacqmin D, Jichlinski P, et al. Photodynamic diagnosis in non-muscle-invasive bladder cancer: a systematic review and cumulative analysis of prospective studies. Eur Urol. 2010 Apr;57(4):595–606.
Mowatt G, N’Dow J, Vale L, Nabi G, Boachie C, Cook JA, et al. Photodynamic diagnosis of bladder cancer compared with white light cystoscopy: Systematic review and meta-analysis. Int J Technol Assess Health Care. 2011 Jan;27(1):3–10.
Turco C, Collà Ruvolo C, Cilio S, Celentano G, Califano G, Creta M, et al. Looking for cystoscopy on YouTube: Are videos a reliable information tool for internet users? Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2022 Mar 29;94(1):57–61.
Capece M, Spirito L, La Rocca R, Napolitano L, Buonopane R, Di Meo S, et al. Hexaminolevulinate blue light cystoscopy (Hal) assisted transurethral resection of the bladder tumour vs white light transurethral resection of the bladder tumour in non-muscle invasive bladder cancer (NMIBC) : a retrospective analysis. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2020 Apr 6;92(1):17–20.
Konecki T, Kutwin P, Łowicki R, Juszczak AB, Jabłonowski Z. Hexaminolevulinate in the Management of Nonmuscle Invasive Bladder Cancer: A Meta-Analysis. Photobiomodulation Photomed Laser Surg. 2019 Sep;37(9):551–8.
Witjes JA, Babjuk M, Gontero P, Jacqmin D, Karl A, Kruck S, et al. Clinical and cost effectiveness of hexaminolevulinate-guided blue-light cystoscopy: evidence review and updated expert recommendations. Eur Urol. 2014 Nov;66(5):863–71.
Riedl CR, Daniltchenko D, Koenig F, Simak R, Loening SA, Pflueger H. Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rate in superficial bladder cancer. J Urol. 2001 Apr;165(4):1121–3.
Filbeck T, Pichlmeier U, Knuechel R, Wieland WF, Roessler W. Clinically relevant improvement of recurrence-free survival with 5-aminolevulinic acid induced fluorescence diagnosis in patients with superficial bladder tumors. J Urol. 2002 Jul;168(1):67–71.
Albarghouth MH, Hamza A. [The impact of using intraoperative photodynamic diagnosis on the prognosis of bladder cancer]. Aktuelle Urol. 2019 Sep 26;
Burger M, Grossman HB, Droller M, Schmidbauer J, Hermann G, Drăgoescu O, et al. Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data. Eur Urol. 2013 Nov;64(5):846–54.
Mariappan P, Rai B, El-Mokadem I, Anderson CH, Lee H, Stewart S, et al. Real-life Experience: Early Recurrence With Hexvix Photodynamic Diagnosis-assisted Transurethral Resection of Bladder Tumour vs Good-quality White Light TURBT in New Non-muscle-invasive Bladder Cancer. Urology. 2015 Aug;86(2):327–31.
Gakis G, Fahmy O. Systematic Review and Meta-Analysis on the Impact of Hexaminolevulinate- Versus White-Light Guided Transurethral Bladder Tumor Resection on Progression in Non-Muscle Invasive Bladder Cancer. Bladder Cancer Amst Neth. 2016 Jul 27;2(3):293–300.
Sun J, Ma X, Shen H, Liu B. Effects of fluorescent light cystoscopy in non-muscle-invasive bladder cancer: A systematic review and meta-analysis. Photodiagnosis Photodyn Ther. 2021 Jun;34:102248.

How to Cite

Lorusso, V., Doisy, L., Granata, A. M., Gregori, A., Manfredi, C., Spirito, L., Sciorio, C., Ciancimino, L. G. M., Molteni, S., Morelli, M., Cirillo, L., Napolitano, L., Walz, J., & Pignot, G. (2022). Could we safely omit a Repeat Transurethral Resection of the Bladder (re-TURB) after Hexaminolevulinate Photodynamic Diagnostics (PDD)-TURB?. Archivio Italiano Di Urologia E Andrologia, 94(4), 424–427. https://doi.org/10.4081/aiua.2022.4.424
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