PROGNOSTIC VALUE OF FLUORESCENT CYSTOSCOPY WITH APPLICATION OF 5¬AMINOLEVULINIC ACID IN PATIENTS WITH URINARY BLADDER CARCINOMA

THE AIM of the investigation was to study the prognostic value of using 5aminolevulinic acid (ALA)fluorescent cystoscopy in transurethral resection (TUR) of tumors of the urinary bladder by an analysis of its sensitivity and specificity as well as a comparison of frequency of recurrence in subgroups of patients after TUR performed by a standard method and with the application of ALA fluorescence. PATIENTS AND METHODS. A retrospective study of the data of primary examination and observations after TUR of 53 patients with transitional cell carcinoma of the bladder (mean age 62±9 years) was carried out.. In these patients 1.5 g of 5ALA (MEDAC, Germany) in 50 ml of 8.4% solution of sodium bicarbonate with pH =6.5 was introduced into the bladder three hours before operation. After standard cytoscopy during TUR the bladder mucosa was illuminated with blue light within the range 375450 nm of the xenon lamp DLight Storz and the fluorescing, in red light, parts were visualized and resected. Within 68 weeks a control fluorescent cytoscopy was performed with a repeated transurethral resection in the area of the primary carcinoma and with a histological investigation of the resected tissue, and 12 months later a standard control cytoscopy was made. The results were compared with the indices of the control group (51 patients) who underwent a standard TUR of the bladder tumor. RESULTS. The sensitivity of a standard cytoscopy to detect carcinoma of the urinary bladder was 96%, the sensitivity, specificity and positive prognostic value of the diagnosis of carcinoma of the urinary bladder with ALAfluorescent cystoscopy was 95%, 42% and 67% respectively. In patients after TUR with ALAfluorescent cystoscopy the areas with malignant urotheium were detected more rarely within 68 weeks as compared with the control group (p=0.005), and 12 months later there were rarer recurrences (p=0.030). CONCLUSION. Standard cytoscopy with the added ALAfluorescence used in TUR in patients with urinary bladder carcinoma allowed the transitional cell carcinomas and prognostically dangerous areas with a high risk of malignant transformation of the urothelium to be identified with high sensitivity and radically resected. The application of fluorescent cytoscopy proved to be a factor corresponding to a low risk of recurrence of carcinoma of the urinary bladder in the nearest postoperative period.

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