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Fluorescence cystoscopy in the diagnostics and treatment of bladder tumors

Evident exophytic urothelial tumors observed in endoscopy are often accompanied by changes of the surrounding tissue even in more remote places, which can be classified äs mucosal atypies of different degree (dysplastic changes), or even äs 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. Huorescence endoscopy (photodynamic diagnostics FDD) 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 sensitivrty 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 (TÜR) 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 Urologie Clinic we used PDD for diagnosis of superficial bladder cancer in 23 cases.