Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy

how many lesions do we miss under white light cystoscopy?

Slawomir G. Kata (Lead / Corresponding author), Abdullah Zreik, Sarfraz Ahmad, Piotr Chłosta, Omar Aboumarzouk

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    INTRODUCTION: There is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy.

    MATERIAL AND METHODS: We retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3-4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy.

    RESULTS: Between July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5% (30/69) patients were found to have bladder lesions, of which 43.3% (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1%) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4%) patients developed minor complications relevant to the photosensitizer.

    CONCLUSIONS: The study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial.

    Original languageEnglish
    Pages (from-to)334-340
    Number of pages7
    JournalCentral European Journal of Urology
    Volume69
    Issue number4
    DOIs
    Publication statusPublished - 30 Nov 2016

    Fingerprint

    Cystoscopy
    Urinary Bladder Neoplasms
    Urologic Neoplasms
    Urinary Bladder
    Light
    Carcinoma in Situ
    Urinary Tract
    Biopsy
    Aminolevulinic Acid
    Photosensitizing Agents
    Endoscopy
    Neoplasms
    Body Weight

    Keywords

    • 5-aminolevulinic acid
    • Photodynamic diagnosis
    • Cystoscopy
    • Ureterorenoscopy
    • Urothelial neoplasms
    • Ureteral neoplasms

    Cite this

    Kata, Slawomir G. ; Zreik, Abdullah ; Ahmad, Sarfraz ; Chłosta, Piotr ; Aboumarzouk, Omar. / Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy : how many lesions do we miss under white light cystoscopy?. In: Central European Journal of Urology. 2016 ; Vol. 69, No. 4. pp. 334-340.
    @article{9df2e4f62c4649adbe396ec88412d25f,
    title = "Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy: how many lesions do we miss under white light cystoscopy?",
    abstract = "INTRODUCTION: There is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy.MATERIAL AND METHODS: We retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3-4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy.RESULTS: Between July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5{\%} (30/69) patients were found to have bladder lesions, of which 43.3{\%} (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1{\%}) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4{\%}) patients developed minor complications relevant to the photosensitizer.CONCLUSIONS: The study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial.",
    keywords = "5-aminolevulinic acid , Photodynamic diagnosis , Cystoscopy , Ureterorenoscopy , Urothelial neoplasms , Ureteral neoplasms",
    author = "Kata, {Slawomir G.} and Abdullah Zreik and Sarfraz Ahmad and Piotr Chłosta and Omar Aboumarzouk",
    note = "The authors gratefully acknowledge the support by The Alfred Stewart Trust, the Scottish Photodynamic Therapy Centre and Medi-lase Charity for their support in carrying out this work.",
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    Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy : how many lesions do we miss under white light cystoscopy? / Kata, Slawomir G. (Lead / Corresponding author); Zreik, Abdullah; Ahmad, Sarfraz; Chłosta, Piotr; Aboumarzouk, Omar.

    In: Central European Journal of Urology, Vol. 69, No. 4, 30.11.2016, p. 334-340.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy

    T2 - how many lesions do we miss under white light cystoscopy?

    AU - Kata, Slawomir G.

    AU - Zreik, Abdullah

    AU - Ahmad, Sarfraz

    AU - Chłosta, Piotr

    AU - Aboumarzouk, Omar

    N1 - The authors gratefully acknowledge the support by The Alfred Stewart Trust, the Scottish Photodynamic Therapy Centre and Medi-lase Charity for their support in carrying out this work.

    PY - 2016/11/30

    Y1 - 2016/11/30

    N2 - INTRODUCTION: There is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy.MATERIAL AND METHODS: We retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3-4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy.RESULTS: Between July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5% (30/69) patients were found to have bladder lesions, of which 43.3% (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1%) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4%) patients developed minor complications relevant to the photosensitizer.CONCLUSIONS: The study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial.

    AB - INTRODUCTION: There is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy.MATERIAL AND METHODS: We retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3-4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy.RESULTS: Between July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5% (30/69) patients were found to have bladder lesions, of which 43.3% (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1%) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4%) patients developed minor complications relevant to the photosensitizer.CONCLUSIONS: The study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial.

    KW - 5-aminolevulinic acid

    KW - Photodynamic diagnosis

    KW - Cystoscopy

    KW - Ureterorenoscopy

    KW - Urothelial neoplasms

    KW - Ureteral neoplasms

    U2 - 10.5173/ceju.2016.896

    DO - 10.5173/ceju.2016.896

    M3 - Article

    VL - 69

    SP - 334

    EP - 340

    JO - Central European Journal of Urology

    JF - Central European Journal of Urology

    SN - 2080-4806

    IS - 4

    ER -