ABSTRACT
OBJECTIVE: To evaluate the effect of hexaminolevulinate (HAL)-induced fluorescence during resection of noninvasive bladder cancer on tumor recurrence compared with resection under white light. METHODS: Between 2008 and 2010, 102 consecutive patients with suspected bladder cancer were randomized to undergo transurethral resection with either conventional white light or combination of white light and HAL-induced fluorescence. Difference in tumor recurrence rate and recurrence-free survival between the 2 groups was evaluated. Subgroup analysis on recurrence-free survival was performed for different tumor parameters. RESULTS: Cystoscopy at 3 months revealed tumor recurrence in 6 of 45 (13.3%) patients of the white light group compared with only 1 of 41 patients of the HAL group (2.4%) (P < .001). The recurrence-free rates in white light patients at 12 and 18 months were 56.3% and 50.6%, respectively, compared with 91% and 82.5% in HAL patients (P = .0006). In subgroup analyses, recurrence-free survival was similar between the 2 groups when solitary tumors were treated (P = .3525). However, the HAL group had a favorable recurrence-free survival compared with the white light group when multifocal tumors (P < .001), primary tumors (P = .0237), recurrent tumors (P = .0189), nonaggressive (papillary urothelial neoplasm of low malignant potential and low grade) tumors (P = .0204), or aggressive (high grade and carcinoma in situ) tumors (P = .0134) were treated. CONCLUSION: HAL significantly aids resection of non-muscle-invasive bladder cancer with the result of reduction in tumor recurrence rates.
Subject(s)
Aminolevulinic Acid/analogs & derivatives , Cystectomy/methods , Light , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/prevention & control , Urinary Bladder Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Female , Fluorescence , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Prospective Studies , Radionuclide Imaging , Urethra , Urinary Bladder Neoplasms/surgeryABSTRACT
INTRODUCTION: Data on general population's and bladder cancer patients' perception of smoking as a risk factor for bladder cancer are limited. To determine urological patients' awareness of smoking as a risk factor for bladder cancer. METHODS: This prospective observational study included 202 consecutive urological inpatients, using a structured questionnaire. We evaluated urological patients' awareness of smoking as a risk factor for bladder cancer and other smoking-related pathologies. Smoker-bladder cancer patients were asked whether they believed that smoking was related to their present bladder problem, whether their treating urologist had ever advised them on the same, and whether they intended to quit. RESULTS: Only 118 of 202 patients (58.4%) stated that they were aware of smoking as a risk factor for bladder cancer, as apposed to 94.6% for chronic obstructive pulmonary disease, 91.6% for heart and vascular problems, and 92.1%, for lung cancer. Perception was unrelated to age, gender, smoking habits, or history of heart or chronic lung disease. Of current smokers/TCC patients, 56.4% believed that smoking is related to their problem and 61.5% intended to quit. The majority (84.6%) had been already warned by their attending physicians. CONCLUSIONS: Urological patients' awareness of smoking as a risk factor for bladder cancer is lower than that for other smoking-related entities. The role of the urologist should not be restricted only to diagnosis and treatment, but should also include counseling patients on the need for radical changes of their life style.
