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Comparison of flexible blue light cystoscopy and rigid blue light cystoscopy in bladder cancer. (A video case demonstration)
5th Meeting of the EAU Section of Uro-Technology (ESUT), 8-10 July 2016, Athens, Greece
O33 Comparison of flexible blue light cystoscopy and rigid blue light cystoscopy in bladder cancer. (A video case demonstration) Zare R. Vestreviken HF Sykehuset Baerum, Dept. of Urology, Rud, Norway INTRODUCTION & OBJECTIVES: Non-Muscle-Invasive Bladder Cancer (NMIBC) is labour intensive and costly to manage. Owing to long-term survival rates and life-long monitoring and treatment (particularly recurrences and complications), it is the most expensive cancer to manage in perpatient terms. Fluorescence-guided cystoscopy, using Hexaminolevulinate (HAL), improves the detection of bladder tumours, particularly carcinoma in situ, compared with standard White-Light (WL) cystoscopy. In 2010, a European expert panel reviewed the evidence for HAL-guided Blue-Light (BL) flexible cystoscopy in the Outpatient (OP) setting. Although studies had shown that flexible BL cystoscopy was feasible and was superior to rigid WL cystoscopy. The 2010 European expert consensus p anel did not recommend BL flexible cystoscopy in the OP setting due image quality. However, they believed that the outcomes would improve as the quality flexible cystoscopy equipment gets upgraded. In 2014 the European expert panel consensus panel indicated that BL flexible cystoscopy may have a role in the management of NMIBC. Improved BL flexible cystoscopy equipment has since been developed that allow the rinsing of the bladder to secure optimal vision. The objective of the video case example is to demonstrate the equipment and procedure and the differences observed with BL rigid cystoscopy compared with BL flexible cystoscopy. MATERIAL & METHODS: A Case example of a patient is presented coming for a regular follow-up at Bærum hospital centre in VestreViken; Oslo, Norway. Fifty mL of HAL was instilled into the bladder and a KARL STORZ PDD SPIES Videocystoscope was used to examine the bladder. The bladder was first inspected under WL, and then then changed to BL to identify tumours and suspicious areas not seen in WL. We discovered multiple papillary tumours in the bladder and the patient was referred to surgery TURB. One hour prior to the TURB, the patient had 50 mL HAL installed into bladder and Olympus Exera II PDD videocystoscope was used to examine the bladder. The bladder was first inspected with WL and then with BL. We discovered multiple papillary tumors. TURB was done following the inspection. RESULTS: The HAL-guided BL flexible cystoscopy procedure resulted in high quality images that improve the visibility of tumours, especially tumours that were smaller compared with WL alone. HAL-guided BL flexible cystoscopy was superior to rigid BL cystoscopy specially by using SPIES CLARA and SPIES CHROMA. CONCLUSIONS: Improvements in the equipment have provided high image quality and superior sensitivity of the BL flexible cystoscope with no loss of fluorescence intensity or diagnostic information compared to rigid cystoscopy, addressing the previous issues identified. Motion ability and suction by flexible PDD videocystoscope is essential advantages for flexible BL compare to rigid BL. The image quality is even better with the use of SPIES CLARA and CHROMA.BL flexible cystoscopy offers a new tool in the management of NMIBC that may increase detection of lesions otherwise not seen under WL examination.
European Urology Supplements 15(6), 2016
166
O33 Comparison of flexible blue light cystoscopy and rigid blue light cystoscopy in bladder cancer. (A video case demonstration) Zare R. Vestreviken HF Sykehuset Baerum, Dept. of Urology, Rud, Norway INTRODUCTION & OBJECTIVES: Non-Muscle-Invasive Bladder Cancer (NMIBC) is labour intensive and costly to manage. Owing to long-term survival rates and life-long monitoring and treatment (particularly recurrences and complications), it is the most expensive cancer to manage in perpatient terms. Fluorescence-guided cystoscopy, using Hexaminolevulinate (HAL), improves the detection of bladder tumours, particularly carcinoma in situ, compared with standard White-Light (WL) cystoscopy. In 2010, a European expert panel reviewed the evidence for HAL-guided Blue-Light (BL) flexible cystoscopy in the Outpatient (OP) setting. Although studies had shown that flexible BL cystoscopy was feasible and was superior to rigid WL cystoscopy. The 2010 European expert consensus p anel did not recommend BL flexible cystoscopy in the OP setting due image quality. However, they believed that the outcomes would improve as the quality flexible cystoscopy equipment gets upgraded. In 2014 the European expert panel consensus panel indicated that BL flexible cystoscopy may have a role in the management of NMIBC. Improved BL flexible cystoscopy equipment has since been developed that allow the rinsing of the bladder to secure optimal vision. The objective of the video case example is to demonstrate the equipment and procedure and the differences observed with BL rigid cystoscopy compared with BL flexible cystoscopy. MATERIAL & METHODS: A Case example of a patient is presented coming for a regular follow-up at Bærum hospital centre in VestreViken; Oslo, Norway. Fifty mL of HAL was instilled into the bladder and a KARL STORZ PDD SPIES Videocystoscope was used to examine the bladder. The bladder was first inspected under WL, and then then changed to BL to identify tumours and suspicious areas not seen in WL. We discovered multiple papillary tumours in the bladder and the patient was referred to surgery TURB. One hour prior to the TURB, the patient had 50 mL HAL installed into bladder and Olympus Exera II PDD videocystoscope was used to examine the bladder. The bladder was first inspected with WL and then with BL. We discovered multiple papillary tumors. TURB was done following the inspection. RESULTS: The HAL-guided BL flexible cystoscopy procedure resulted in high quality images that improve the visibility of tumours, especially tumours that were smaller compared with WL alone. HAL-guided BL flexible cystoscopy was superior to rigid BL cystoscopy specially by using SPIES CLARA and SPIES CHROMA. CONCLUSIONS: Improvements in the equipment have provided high image quality and superior sensitivity of the BL flexible cystoscope with no loss of fluorescence intensity or diagnostic information compared to rigid cystoscopy, addressing the previous issues identified. Motion ability and suction by flexible PDD videocystoscope is essential advantages for flexible BL compare to rigid BL. The image quality is even better with the use of SPIES CLARA and CHROMA.BL flexible cystoscopy offers a new tool in the management of NMIBC that may increase detection of lesions otherwise not seen under WL examination.
European Urology Supplements 15(6), 2016
166