Fluorescence cystoscopy in the diagnostics and treatment of bladder
Petrík R., *Jirsa M., **Dvorák E., **koda V., ***Stádník B.
1st Faculty of Medicine, Charles University Prague, *1st Medical
Clinic, 1st Faculty of Medicine, Charles University Prague, **Precioza Crytur,
***Institute of Radioengineering and Electronics, Academy of Sciences of the Czech
exophytic urothelial tumors observed in endoscopy are often accompanied by changes of the
surrounding tissue even in more remote places, which can be classified as mucosal atypies
of different degree (dysplastic changes), or even as carcinoma in situ. Though these
changes often cannot be diagnosed, especially by direct vision optic method, they
represent potential tumor for the future. For this reason it is necessary to use methods
which could discover these areas for early treatment. Fluorescence endoscopy (photodynamic
diagnostics - PDD) is the method of choice which enables to solve this problem. Using this
method, we can detect even very small malignant disseminated tumors which would be
overlooked, especially by direct vision optic method. Just these small tumors are often
cause of early false recurrences. The specificity of this method is up to 90% and the
sensitivity 100% (Kriegmaier).
Fluorescence endoscopy after 5-aminolevulinic acid (ALA) application is
mostly indicated for diagnosis of bladder cancer especially :
1) In cases with multicentric superficial tumors when transurethral
resection (TUR) of all tumors is proposed.
2) In patients with positive cytology and negative white light
endoscopy (carcinoma in situ). In these cases the diagnosis can be supported by targeted
biopsy of fluorescent spots. In positive findings early local application of cytostatics
can be started.
PDD can be used if the capacity of bladder is sufficient and the patient is able to
retain the solution for at least 90 minutes. At the Urologic Clinic we used PDD for
diagnosis of superficial bladder cancer in 23 cases.
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