Non-muscle-invasive bladder cancer: a vision for the future.

The management of non-muscle-invasive bladder cancer (NMIBC) has evolved from the first reports on bladder endoscopy and transurethral resection to the introduction of adjuvant intravesical treatment. However, disease recurrence and progression remain an ongoing risk, placing a heavy burden on healthcare resources and on patients' quality of life. Deeper understanding of the molecular basis of the disease and developments in optics, lasers and computer science are already offering opportunities to revolutionize care and improve long-term prognosis.

Clinical and cost effectiveness of hexaminolevulinate-guided blue-light cystoscopy: evidence review and updated expert recommendations.

Context: Non-muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence risk, partly because of the persistence of lesions following transurethral resection of bladder tumour (TURBT) due to the presence of multiple lesions and the difficulty in identifying the exact extent and location of tumours using standard white-light cystoscopy (WLC). Hexaminolevulinate (HAL) is an optical-imaging agent used with blue-light cystoscopy (BLC) in NMIBC diagnosis. Increasing evidence from long-term follow-up confirms the benefits of BLC over WLC in terms of increased detection and reduced recurrence rates.

Safety of hexaminolevulinate for blue light cystoscopy in bladder cancer. A combined analysis of the trials used for registration and postmarketing data.

Objective: To detail and put into perspective, safety of hexaminolevulinate blue light cystoscopy (HAL-BLC), including repeated use, based on combined data of controlled trials used for registration of HAL and postmarketing experience.

Methods: Safety data of 2 randomized comparative studies (group 1) and 4 within patient control studies (group 2) were combined. Postmarketing data from >200,000 patients were analyzed.

Hexyl aminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: a critical review of the current literature.

Context: Controversy exists regarding the therapeutic benefit and cost effectiveness of photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) or hexyl aminolevulinate (HAL) in addition to white-light cystoscopy (WLC) in the management of non-muscle-invasive bladder cancer (NMIBC).

Objective: To systematically evaluate evidence regarding the therapeutic benefits and economic considerations of PDD in NMIBC detection and treatment.

Evidence Acquisition: We performed a critical review of PubMed/Medline, Embase, and the Cochrane Library in October 2012 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement.

Urine colour after radical prostatectomy predicts urinary leakage at the vesicourethral anastomosis.

Objective: The aim of this investigation was to determine whether postoperative urine colour could be used as a predictor for the presence or absence of a urinary leakage at the vesicourethral anastomosis after open radical prostatectomy.

Material And Methods: In this prospective study, the urine colour of 223 patients who underwent open radical prostatectomy due to histologically proven localized prostate cancer was assessed macroscopically and microscopically on postoperative day (POD) 6, 7 and 8. All patients underwent evaluation of perianastomotic extravasation by retrograde cystography on POD 8.

The impact of bladder neck mucosal eversion during open radical prostatectomy on bladder neck stricture and urinary extravasation.

Purpose: To determine whether the bladder neck mucosal eversion (BNM-eversion) during radical retropubic prostatectomy (RRP) reduces the risk of bladder neck stricture (BNS) and of peri-anastomotic extravasation (PAE) in postoperative cystography.

Methods: Two hundred and eleven patients with clinically localized prostate cancer underwent RRP and were prospectively randomized into patients with BNM-eversion (group I) and without BNM-eversion (group II). All patients underwent an evaluation of PAE by retrograde cystography on postoperative day 8.

Photodynamic therapy of bladder cancer - a phase I study using hexaminolevulinate (HAL).

Objectives: To assess the safety and feasibility of hexaminolevulinate (HAL) based photodynamic therapy (PDT) as adjuvant treatment after transurethral resection of the bladder (TURB) in patients with intermediate or high-risk urothelial cell carcinoma (UCC) of the bladder.

Materials And Methods: Seventeen patients received 50 ml of either a 16 mM (4 patients) or 8 mM HAL (13 patients) solution instilled intravesically. Bladder wall irradiation was performed using an incoherent white light source coupled via a quartz fiber assembled into a flexible transurethral irrigation catheter.

Individual learning curve reduces the clinical value of urinary cytology.

Unlabelled: The aim of the study was to define the learning curve of a single cytologist as a limitation of urinary cytology. A total of 1034 cytologic and histologic findings of patients undergoing transurethral resection of the bladder for suspicion of bladder cancer were reviewed, and cytologic evaluations of a single cytologist from the beginning of his learning period were compared with the results of a cytologist at a national reference center. Our results showed that the individual learning curve has a significant impact on the quality of urine cytology.

Detection of urinary leakage after radical retropubic prostatectomy by contrast enhanced ultrasound - do we still need conventional retrograde cystography?

Introduction: To prospectively evaluate the accuracy of transvesical contrast-enhanced ultrasound (CEUS) as an alternative method for the detection of anastomotic leakage after radical retropubic prostatectomy (RRP) in comparison with the current standard method of conventional retrograde cystography (CG).

Patients And Methods: Forty-three patients underwent RRP for histologically proven localized prostate cancer. The vesico-urethral anastomosis was evaluated 8 days after RRP by CG and CEUS.

Photodynamic diagnosis in patients with T1G3 bladder cancer: influence on recurrence rate.

Introduction: Therapeutic strategies on treatment of T1G3 urothelial cancer of the urinary bladder are controversial. The objective of this study was to investigate the impact of photodynamic diagnosis (PDD) on the recurrence-free survival rate of patients with the initial diagnosis of T1G3 bladder cancer.

Patients And Methods: Between 1995 and 2007, 153 patients were treated for T1G3 bladder cancer at our institution.

Fluorescence in situ hybridisation in the diagnosis of upper urinary tract tumours.

Background: Upper urinary tract (UUT) tumours are often a diagnostic challenge. Because of delayed diagnosis at an advanced stage, prognosis is less qualitative when compared to bladder tumours. There is, therefore, a need for reliable markers to improve diagnosis.

Urinary cytology in era of fluorescence endoscopy: redefining the role of an established method with a new reference standard.

Objectives: To assess whether the use of fluorescence endoscopy (FE) decreases the clinical value of urinary cytology compared with the use of white light endoscopy (WLE).

Methods: The endoscopic, cytologic, and histologic findings of patients who had undergone transurethral resection of the bladder with or without FE were reviewed. The number and characteristics of the tumors that had been overlooked by WLE or FE but detected by cytology were analyzed.

Influence of clinical information on the interpretation of urinary cytology in bladder cancer: how suggestible is a cytologist?

Objective: to determine the influence of the knowledge of the endoscopic findings and the influence of the patient's history on the cytologist's judgement, as urinary cytology is known to be subjective and has several limitations, in particular a high inter- and intra-observer variability.

Patients And Methods: we analysed the cytological and histological findings of patients who underwent transurethral resection of a bladder tumour, and determined whether the cytologist was aware of the endoscopic findings or not. The sensitivity and specificity of cytology were calculated with or without this knowledge, and that of the patients' bladder cancer history.

Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations.

Context: Compared with standard white-light cystoscopy, photodynamic diagnosis with blue light and the photosensitiser hexaminolevulinate has been shown to improve the visualisation of bladder tumours, reduce residual tumour rates by at least 20%, and improve recurrence-free survival. There is currently no overall European consensus outlining specifically where hexaminolevulinate is or is not indicated.

Objective: Our aim was to define specific indications for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of non-muscle-invasive bladder cancer (NMIBC).

Predicting individual outcomes after radical cystectomy: an external validation of current nomograms.

Objective: To determine whether published nomograms, i.e. The International Bladder Cancer Nomogram Consortium (IBCNC) and the Bladder Cancer Research Consortium (BCRC) statistical models for predicting disease recurrence and survival of patients after radical cystectomy, are feasible for routine use in intermediate-volume institutions in Europe, as although these nomograms had high accuracy by internal validation tests, they stem from high-volume centres and have not been validated elsewhere and thus their general applicability remains unproven.

Radical cystectomy in the elderly patient: a contemporary comparison of perioperative complications in a single institution series.

Purpose: To report on our recent experience with peri- and postoperative morbidity of radical cystectomy in patients 75 years and older compared to younger patients.

Patients And Methods: Medical records of 326 consecutive patients undergoing radical cystectomy from May 2004 through April 2008 were reviewed.

Results: Eighty-five of 326 patients (26%) were > or =75 years (75-95) old.

Hexaminolevulinate is equal to 5-aminolevulinic acid concerning residual tumor and recurrence rate following photodynamic diagnostic assisted transurethral resection of bladder tumors.

Objectives: To compare the outcomes of 5-aminolaevulinic acid (ALA) vs hexaminolaevulinate (HEX) vs white light (WL) transurethral resection of bladder tumors (TURB) to assess transferability of ALA findings to HEX. Extending WL-TURB with photodynamic diagnostic improves outcome. Two fluorescent agents have been commonly used for this.

Intraoperative photodynamic evaluation of surgical margins during endoscopic extraperitoneal radical prostatectomy with the use of 5-aminolevulinic acid.

Purpose: Today there are no established techniques to image positive surgical margins (PSM) intraoperatively in endoscopic extraperitoneal radical prostatectomy (EERPE). The intention of this study was to describe the specific technique of photodynamic diagnosis (PDD) in patients undergoing EERPE and report on the potential to detect PSM under PDD.

Materials And Methods: Twenty-four patients with clinically organ-confined prostate cancer received 5-aminolevulinic acid 20 mg/kg body weight orally 3 hours prior to nonnerve-sparing EERPE.

Photodynamic diagnosis using 5-aminolevulinic acid for the detection of positive surgical margins during radical prostatectomy in patients with carcinoma of the prostate: a multicentre, prospective, phase 2 trial of a diagnostic procedure.

Background: Surgical margin status after radical prostatectomy (RP) is a significant risk factor for tumour recurrence. It is an intriguing concept to find a fluorescence marker for photodynamic diagnosis (PDD) to make tumour margins visible during surgery.

Objective: To investigate the feasibility of identification of positive surgical margins (PSM) during open retropubic or endoscopic extraperitoneal RP by 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) to enhance surgical radicality.

Optical coherence tomography (OCT): ready for the diagnosis of a nephrogenic adenoma of the urinary bladder?

The feasibility of Optical Coherence Tomography (OCT) as a non-invasive technique was shown in different fields. We investigated OCT's potential to detect nephrogenic adenoma (NA) within the human bladder. Clinically non-invasive methods like ultrasonography or CT have significant limitations.

Positive urine cytology but negative white-light cystoscopy: an indication for fluorescence cystoscopy?

Objective: To evaluate the possible benefit of fluorescence cystoscopy (FC) in detecting cytologically 'confirmed' lesions when assessing urothelial carcinoma of the bladder, as negative white-light cystoscopy in cases of a positive cytological finding represents a diagnostic dilemma.

Patients And Methods: From January 1996 to December 2006, 348 patients, who had cystoscopy for surveillance or due to suspicion of urothelial carcinoma, presented with an entirely negative white-light cystoscopy at our hospital. However, 77 of the 348 patients (22.

Metastatic renal cell carcinoma: results of a population-based study with 25 years follow-up.

Background: Renal cell carcinoma (RCC) is the sixth leading cause of death in developed countries. A third of all RCC patients are confronted with metastatic disease. Since their approval in 2005 and 2006 in the USA, new targeted therapies may lead to substantial progress.

Adenocarcinoma of the bladder following nephrogenic adenoma: a case report.

Introduction: Nephrogenic adenomas are generally considered to be benign lesions, but there remains a risk for malignant transformation. Patients with immunosuppression in particular appear to be at a higher risk of malignant disease. We report a case of post-traumatic nephrogenic adenoma in a young patient without immunosuppression, which transformed into an adenocarcinoma of the bladder.

Does the current World Health Organization classification predict the outcome better in patients with noninvasive bladder cancer of early or regular onset?

Objective: To compare the clinical outcome and prognostic power of the former and current World Health Organization (WHO) grading system in patients with early vs regular onset of noninvasive urothelial bladder cancer (UBC), as little is known of the natural history of early onset UBC and in how far it is reflected by histopathological grading and staging in guiding clinical decisions.

Patients And Methods: The medical records of 69 consecutive patients presenting with initial UBC of early onset (>or=45 years old, EO) and of 100 randomly chosen patients with regular onset (RO) were reviewed. There were no significant differences in gender distribution, risk factors or tumour stage.