Fluorescence endoscopi in the diagnosis and treatment of superficial bladder neoplasms

Aim. The results of a clinical investigation on neoplasm and bladder dysplasia detection by 5-aminolaevulinic acid (5-ALA)-induced fluorescence are reported. In this paper the authors report their experience with 5-ALA in the diagnosis, tretament and follow-up of bladder neoplasms after chemotherapy and endocavitary immunotherapy. Methods. The 5-ALA was instilled in the bladder 2 h before bladder transurethral resection. This method has been used since December 2000 on 163 patients and a total of 266 biopsies were histologically examined. Results. One-hundred and four benign and 92 malignant/dysplastic areas were biopsied; 46 malignant/dysplastic lesions were not detected during routine white-light cystoscopy but were identified with fluorescence cystoscopy. Sensitivity was 99% but specificity was low (20%). Conclusion. ALA-based fluorescence cystoscopy is a safe and simple technique that enhances the detection of flat and papillary urothelial neoplasms.