7° Congresso Nazionale

42
7° Congresso Nazionale Associazione Italiana di Endourologia
5-ALA induced FC. To confirm these findings, European
multicentre long-term follow-up studies are ongoing.
Filbeck et al. published preliminary results, showing a significant
higher recurrence-free survival in the FC group
(89.6% vs. 65.9% at 24 months - p = 0.004). Recurrencefree
survival after 12 and 24 months was 73.8% and 65.9%
in the WLC group and 89.6% and 89.6% in the FC group,
respectively (14).
Recently, it has been shown that the esterification of ALA
into more lipophilic derivates, such as Hexaminolevulinate
(HAL) (Hexvix ® ) results in up to 25-fold increase of the fluorescence
compound Protoporphyrin IX (15,16). HAL has
several advantages compared to 5-ALA: 1) intravesical
administration rather than systemic administration, 2) the
need of a shorter instillation time (one hour), 3) higher
selectivity and brighter fluorescence, 4) better contrast, 5)
less photobleeching. These characteristics have the potential
to make this technique a significant improvement in the
detection of bladder tumours and in patient management.
Several studies have been already published showing the
feasibility and accuracy of HAL cistoscopy (17-19).
Schmidbauer et al. were able to detect 28% more patients
with CIS with HAL cystoscopy as compared to WLC.18
Jocham et al. observed a significantly improved tumor
detection rate compared to WLC (96% vs. 77%), particularly
for dysplasia (93% vs. 48%), CIS (95% vs. 68%) and
superficial papillary tumors (96% vs. 85%) (19).
Furthermore, Witjes et al. and Loidl et al. have shown that
HAL flexible cystoscopy is feasible and accurate, with
results that are comparable to white light cystoscopy and
slightly inferior to rigid HAL cystoscopy (20,21).
Large multicentre, randomized prospective trials are needed
to confirm the role of HAL cystoscopy in the diagnosis
and treatment of bladder tumour and to assess whether
HAL cystoscopy is able to decrease the rate of residual
tumors after TURBT and to increase long-term recurrence
free survival.
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