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


https://doi.org/10.4081/aiua.2022.4.424
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: 519
PDF: 250
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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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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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