Skip to main content
SpringerLink
Log in

Cystoscopy and Enhanced Diagnostics

  • Chapter
  • First Online:
Bladder Cancer

  • 1083 Accesses

Abstract

Reliable visualization of bladder tumors is crucial to the success of cancer surveillance strategies and curative intent transurethral resection of bladder tumor. Compared to conventional white light cystoscopy enhanced technologies applied to cystoscopy consistently demonstrate white light fails to detect all bladder tumors. Photodynamic diagnosis with fluorescence-emitting fluorophores and technologies focused on enhanced vascular contrast are in current use to improve bladder cancer visualization and reduced cancer recurrence rates when used in conjunction with white light. Enhanced technologies focused on creating digitally contrasted images from conventional white light cystoscopy or providing information about histopathology are under investigation. The simultaneous use of more than one enhanced technology during the same cystoscopy may lead to greater improvement in patient care. The future of enhanced cystoscopy improving patient care is promising.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Bladder Cancer. https://seer.cancer.gov/statfacts/html

  2. Canter DJ, Revenig LM, Smith ZL, Dobbs RW, Malkowicz SB, Issa MM, et al. Re-examination of the natural history of high-grade-T1 bladder cancer using a large contemporary cohort. Int Braz J Urol. 2014;40(2):172–8.

    Article  PubMed  Google Scholar 

  3. Cookson MS, Chang SS, Oefelein MG, Gallagher JR, Schwartz B, Heap K. National practice patterns for immediate postoperative instillation of chemotherapy in nonmuscle invasive bladder cancer. J Urol. 2012;187(5):1571–6.

    Article  PubMed  Google Scholar 

  4. Rieken M, Xylinas E, Kluth L, Crivelli JJ, Chrystal J, Faison T, et al. Long-term cancer-specific outcomes of TaG1 urothelial cancer of the bladder. Eur Urol. 2014;65(1):201–9.

    Article  PubMed  Google Scholar 

  5. Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49(3):466–77.

    Article  PubMed  Google Scholar 

  6. Rink M, Babjuk M, Catto JWF, Jichlinski P, Shariat SF, Stenzl A, et al. Hexyl aminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle invasive bladder cancer: a critical review of the current literature. Eur Urol. 2013;64(4):624–38.

    Article  PubMed  Google Scholar 

  7. Jocham D, Witjes F, Wagner S, Jichlinski P, Guillou L, Karlsen SJ, et al. Improved detection and treatment of bladder cancer using hexaminolevulinate imaging: a prospective, phase III multicenter study. J Urol. 2005;174(1):862–6.

    Article  PubMed  Google Scholar 

  8. Grossman HB, Gomella L, Fradet Y, Morales A, Presti J, Ritenour C, et al. A phase III, multicenter comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of superficial papillary lesions in patients with bladder cancer. J Urol. 2007;178(1):62–7.

    Article  PubMed  Google Scholar 

  9. Fradet Y, Grossman HB, Gomella L, Lerner S, Cookson M, Albala D, et al. A comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of carcinoma in situ in patients with bladder cancer: a phase III, multicenter study. J Urol. 2007;178(1):68–73.

    Article  PubMed  Google Scholar 

  10. Gow JC. Harold Hopkins and optical systems for urology-an appreciation. Urology. 1998;52(1):152–7.

    CAS  PubMed  Google Scholar 

  11. Samplaski MK, Jones JS. Two centuries of cystoscopy: the development of imaging instrumentation and synergistic technologies. BJU Int. 2009;103(2):154–8.

    Article  PubMed  Google Scholar 

  12. Cockett WS, Cockett AT. The Hopkins rod-lens system and the Storz cold light illumination system. Urology. 1998;51(5A suppl):1–2.

    Article  CAS  PubMed  Google Scholar 

  13. Marti A, Jichlinski P, Lange N, Ballini JP, Guillou L, Leisinger HJ, et al. Comparison of aminolevulinic acid and hexylesteraminolevulinate induced protoporphyrin IX distribution in human bladder cancer. J Urol. 2003;170(2):428–32.

    Article  CAS  PubMed  Google Scholar 

  14. Krieg RC, Herr A, Raupach K, Ren Q, Schwanborn K, Knuechel R, et al. Analyzing effects of photodynamic therapy with 5-aminolevulinic acid (ALA) induced protoporphyrin IX (PPIX) in urothelial cells using reverse phase protein arrays. Photochem Photobiol Sci. 2007;6(12):1296–305.

    Article  CAS  PubMed  Google Scholar 

  15. Stenzl A, Burger M, Fradet Y, Mynderse LA, Soloway MD, Witjes JA, et al. Hexaminolevulinate-guided fluorescence cystoscopy reduces recurrence in patients with nonmuscle invasive bladder cancer. J Urol. 2010;184(5):1907–13.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hermann GG, Mogensen K, Carlsson S, Marcussen N, Dunn S. Fluorescence-guided transurethral resection of bladder tumors reduces bladder tumor recurrence due to less residual tumor tissue in Ta/T1 patients: a randomized two-centre study. BJU Int. 2011;108(2):E297–E3003.

    Article  PubMed  Google Scholar 

  17. Grossman HB, Stenzl A, Fradet Y, Mynderse LA, Kriegmair M, Witjes JA, et al. Long-term reduction in bladder cancer recurrence with hexaminolevulinate-enabled fluorescence cystoscopy. J Urol. 2012;188(1):58–62.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Palou J, Hernandez C, Sosona E, Abascal R, Burgues JP, Rioja C, et al. Effectiveness of hexaminolevulinate fluorescence cystoscopy for the diagnosis of non-muscle invasive bladder cancer in daily clinical practice: a Spanish multicenter observational study. BJU Int. 2015;116(1):37–43.

    Article  PubMed  Google Scholar 

  19. Burger M, Grossman HB, Droller M, Schmidbauer J, Hermann G, Dragoescu O, et al. Photodynamic diagnosis of non-muscle invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data. Eur Urol. 2013;64(5):846–54.

    Article  PubMed  Google Scholar 

  20. Mark JR, Gelpi-Hammerschmidt F, Trabulsi EJ, Gomella LG. “Blue light” cystoscopy for detection and treatment of non-muscle invasive bladder cancer. Can J Urol. 2012;19(2):6627–231.

    Google Scholar 

  21. Hermann GG, Mogensen K, Carlsson S, Marcussen N, Dunn S. Fluorescence-guided transurethral resection of bladder tumours reduces bladder tumour recurrence due to less residual tumour tissue in Ta/Ta patients: a randomized two- centre study. BJU Int. 2011;108:E297–303.

    Article  PubMed  Google Scholar 

  22. Bazargani ST, Djaladat H, Schuckman AK, Hugen CM, Daneshmand S. Videourology. 2018;32(2):vid.2017.0073.

    Article  PubMed  Google Scholar 

  23. Chang SS et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. AUA. 2016. https://www.auanet.org/eduction/guidelines/non-muscle-invasive-bladder-cancer.cfm.

  24. Babjuk M, et al. EAU guidelines on non-muscle invasive urothelial carcinoma of the bladder: update 2016. Eur Urol. 2017;71(1):447–61.

    Article  PubMed  Google Scholar 

  25. Schneeweiss S, Kriegmair M, Stepp H. Is everything all right if nothing seems wrong? A simple method of assessing the diagnostic value of endoscopic procedures when a gold standard is absent. J Urol. 1999;161(4):1116–9.

    Article  CAS  PubMed  Google Scholar 

  26. Daneshmand S, Patel S, Lotan Y, Pohar K, Trabulsi E, Woods M, et al. Efficacy and safety of blue light flexible cystoscopy with hexaminolevulinate in the surveillance of bladder cancer: a phase III, comparative, multicenter study. J Urol. 2018;199(5):1158–65.

    Article  PubMed  Google Scholar 

  27. Lane GI, Downs TM, Soubra A, Rao A, Hemsley L, Laylan C, et al. Tolerability of repeat use of blue light cystoscopy with hexaminolevulinate for patients with urothelial cell carcinoma. J Urol. 2017;197(3):596–601.

    Article  PubMed  Google Scholar 

  28. Apfelbeck M, Grimm T, Kretschmer A, Buchner A, Schneevoigt BS, Jokisch F, et al. Follow-up of high-risk bladder cancer – is safe to perform fluorescence endoscopy multiple times in the same patient? Urol Oncol. 2017;35(10):602.e19–23.

    Article  Google Scholar 

  29. Zare R, Grabe M, Hermann GG, et al. Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration. Res Reports Urol. 2018;10:151–7.

    Article  Google Scholar 

  30. Lotan Y, Chaplin I, Ahmadi H, Meng X, Roberts S, Ladi-Seyedian S, et al. Prospective evaluation of blue-light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer. BJU Int. 2021;127(1):108–13.

    Article  CAS  PubMed  Google Scholar 

  31. Lotan Y, Bivalacqua TJ, Downs T, et al. Blue light flexible cystoscopy with hexaminolevulinate in non-muscle invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA-update 2018. Nat Rev Urol. 2019;16:377–86.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lerner SP, Goh A. Novel endoscopic diagnosis for bladder cancer. Cancer. 2015;121(2):169–78.

    Article  PubMed  Google Scholar 

  33. Lee JY, Cho KS, Kang DH, Jung HD, Kwon JK, Oh CK, et al. A network meta-analysis of therapeutic outcomes after new image technology-assisted transurethral resection for non-muscle invasive bladder cancer: 5-aminolaevulinic acid fluoresecence vs. hexylaminolevulinate flurorescence vs. narrow-band imaging. BMC Cancer. 2015;15(3):566–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kang W, Cui Z, Chen Q, Zhang D, Zhang H, Jin X. Narrow-band imaging-assisted transurethral resection reduces the recurrence risk of non-muscle invasive bladder cancer: a systematic review and meta-analysis. Oncotarget. 2017;4(8):238880–90.

    Google Scholar 

  35. Naito S, Algaba F, Babjuk M, Bryan RT, Sun YH, Valiquette L, et al. The Clinical Research Office of the Endourological Society (CROES) Multicentre randomized trial of narrow-band imaging-assisted transurethral resection of bladder tumor (TURBT) versus conventional white light imaging-assisted TURBT in primary non-muscle invasive bladder cancer patients: trial protocol and 1-year results. Eur Urol. 2016;70(3):506–15.

    Article  PubMed  Google Scholar 

  36. Kim SB, Yoon SG, Tae J, Kim JY, Shim JS, Kang SG, et al. Detection and recurrence rate of transurethral resection of bladder tumors by narrow-band imaging: prospective, randomized comparison with white light cystoscopy. Investig Clin Urol. 2018;59(2):98–105.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tschirdewahn S, Harke NN, Hirner L, Stagge E, Hadaschik B, Eisenhardt A. Narrow-band imaging-assisted cystoscopy in the follow-up of patients with transitional cell carcinoma of the bladder: a randomized study in comparison with white light cystoscopy. World J Urol. 2020;38:1509–15.

    Article  CAS  PubMed  Google Scholar 

  38. Kamphuis GM, de Bruin DM, Brandt MJ, Knoll T, Conort P, Lapini A, et al. Comparing image perception of bladder tumors in four different Storz Professional Image Enhancement System modalities using the iSPIES app. J Endourol. 2016;30(5):602–8.

    Article  PubMed  Google Scholar 

  39. Gravas S, Stenzl A. The Storz professional image enhancement system (SPIES) non-muscle invasive bladder cancer study: a multicenter international randomized controlled study. J Endourol. 2014;28(11):1254–5.

    PubMed  Google Scholar 

  40. Lerner SP, Goh A. Novel endoscopic diagnosis for bladder cancer. Cancer. 2015;121(2):169–78.

    Article  PubMed  Google Scholar 

  41. Ren H, Waltzer WC, Bhalla R, Liu J, Yuan Z, Lee CD, et al. Diagnosis of bladder cancer with microelectromechanical systems-based cystoscopic optical coherence tomography. Urology. 2009;74(6):1351–7.

    Article  PubMed  Google Scholar 

  42. Manyak MJ, Gladkova ND, Makari JH, Schwartz AM, Zagaynova EV, Zolfaghari L, et al. Evaluation of superficial bladder transitional-cell carcinoma by optical coherence tomography. J Endourol. 2005;19(5):570–4.

    Article  PubMed  Google Scholar 

  43. Lingley-Papadopoulos CA, Loew MH, Manyak MJ, Zara JM. Computer recognition of cancer in the urinary bladder using optical coherence tomorgraphy and texture analysis. J Biomed Opt. 2008;13(2):024003.

    Article  PubMed  Google Scholar 

  44. Ren H, Yuan Z, Waltzer W, Shroyer K, Pan Y. Enhancing detection of bladder carcinoma in situ by 3-dimensional optical coherence tomography. J Urol. 2010;184(4):1499–506.

    Article  PubMed  Google Scholar 

  45. Ren H, Park KC, Pan R, Waltzer WC, Shroyer KR, Pan Y. Early detection of carcinoma in situ of the bladder: a comparative study of white light cystoscopy, narrow-band imaging, 5-ALA fluorescence cystoscopy and 3-dimensional optical coherence tomography. J Urol. 2012;187(3):1063–70.

    Article  PubMed  Google Scholar 

  46. Schmidbauer J, Remzi M, Klatte T, Waldert M, Mauermann J, Susani M, et al. Fluorescence cystoscopy with high-resolution optical coherence tomography imaging as an adjunct reduces false-positive findings in the diagnosis of urothelial carcinoma of the bladder. Eur Urol. 2009;56(6):914–9.

    Article  PubMed  Google Scholar 

  47. Naya Y, Takaha N, Okubo T, Shiota K, Hayashi I, Mori M, et al. Probe-based confocal laser endomicroscopy using acrinol as a novel dye can be used to observe cancer nuclei of bladder carcinoma in situ. J Endourol Case Rep. 2018;4(1):25–7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Bui D, Mach KE, Zlatev DV, Rouse RV, Leppert JT, Liao JC. A pilot study of in vivo confocal laser endomicroscopy of upper tract urothelial carcinoma. J Endourol. 2015;29(12):1418–23.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Liem EI, Freund JE, Baard J, de Bruin DM, Laguna MP, Savci-Heijink CD, et al. Confocal laser endomicroscopy for the diagnosis of urothelial carcinoma in the bladder and the upper urinary tract: protocols for two prospective explorative studies. JMIR Res Protoc. 2018;7(2):e34.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Liem EI, Freund JE, Baard J, de Bruin DM, Laguna MP, Savci-Heijink CD, et al. Validation of confocal laser endomicroscopy features of bladder cancer: the next step towards real-time histologic grading. Eur Urol Focus. 2020;6(1):81–7.

    Article  PubMed  Google Scholar 

  51. Dimitriadis N, Grychtol B, Theuring M, Behr T, Sippel C, Deliolanis NC. Spectral and temporal multiplexing for multispectral fluorescence and reflectance imaging using two color sensors. Opt Express. 2017;25:12812–29.

    Article  CAS  PubMed  Google Scholar 

  52. Kriegmair MC, Rother J, Grychtol B, Theuring M, Ritter M, Gunes C, et al. Multiparametric cystoscopy for detection of bladder cancer using real-time multispectral imaging. Eur Urol. 2020;77:251–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The Ohio State University, Columbus, OH, USA

    Kamal S. Pohar

Authors
  1. Kamal S. Pohar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kamal S. Pohar .

Editor information

Editors and Affiliations

  1. Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Ashish M. Kamat

  2. Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada

    Peter C. Black

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pohar, K.S. (2021). Cystoscopy and Enhanced Diagnostics. In: Kamat, A.M., Black, P.C. (eds) Bladder Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-70646-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-70646-3_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-70645-6

  • Online ISBN: 978-3-030-70646-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation