PTU - Polskie Towarzystwo Urologiczne
list of articles:

Use of photodynamic method in diagnosis and in efficacy of transurethral resection of superficial bladder tumours
Article published in Urologia Polska 2001/54/1.


Marek Lipiński, Leszek Jeromin
Klinika Urologii Instytutu Chirurgii Akademii Medycznej w Łodzi Kierownik Kliniki: prof, dr hab. mcd. Leszek Jeromin


urinary bladder, carcinoma, photodynamic diagnosis, 5 aminolevulinic acid, treatment, transurethral resection


Objectives. Early diagnosis of urinary bladder tumours is essential for effective treatment. Photodynamic phenomenon is caused by 5-ALA, which is a precursory of fluoroscopic porfiryncs that arc visible in the ultraviolet (UV) light after they entered a tumour cell. 5-ALA has a great value in early diagnosis of superficial bladder tumours, because it makes it possible to recognize early stages of tumours invisible in ordinary light used in cystoscopy.
Material and methods. 61 patients (pts) with biopsy confirmed bladder tumour were cystoscopically (123 procedures) observed under 5-ALA instillation. Results were assessed in ordinary light and UV-Light Storz and additionally in laser light in 9 pts. 40 pis were observed after transurethral resection of tumours (TUR).
Results. 21 pts (12 after TUR) had fluorescent areas, visible in UV-Light or laser only. 24 pts (15 alter TUR) without changes in normal cystoscopic light, presents red fluorescent areas in UV-Light with atypical changes confirmed histologically. In 16 pts (including 13 alter TUR) no changes were observed in normal and UV-Light.
Conclusion. Use of 5-ALA allowed for the early diagnosis of superficial bladder tumours and made radicality of endoscopic operation.


  1. [I] Dougherty T. J.. A brief history of clinical photodynamic therapy development at Rosweil Park Cancer Institute. J. Clin. Laser. Med. Surg. 1996,14,219-221.
  2. [2] Filbcck T., Roesslcr W., Knuechcl R.. Slraub M. Kiel 11. J., Wie-land. W. F.: S aminolevulinic acid induced fluorescence endoscopy applied at secondary- transurethral resection after conventional resection of primary superficial bladder tumors. Urology. 1999,53,77-81.
  3. [3] Gronlund-Pakkancn S., Makincn K., Talja M., Kuusisto A.. Alhava E.: The importance of fluorescence distribution and kinetics of ALA-induced PplX in the bladder in photodynamic therapy. J. Photochem. Pholobiol. B. 1997,38.269-273.
  4. [4] Herman M. A., Webber J.. Fromm D.. Kesse. I): Hemodynamic effects of 5a-aminole\\\\itlink acid in humans, i. Photochem. Pho-tobioLB. 1998,43,61-65.
  5. / \\\'S] Jeromin L.. Lipiński M.: Wartośćfotosensytyzera w rozpoznawaniu i leczeniu powierzchownych nowotworów nabłonkowych pęcherza moczowego. Videochimrgia I999.4.57-60.
  6. jf>] Kennedy J. C, Marcus S. L., Potlier R. H.: Phototlynamic therapy (PDTj and photodiagnosis (PD) using endogenous pholosenxi-tization induced by 5aininoIevulinic acid (ALA): mechanisms and clinical results, J. Clin. Laser. Med. Surg. 1996. 14.289-304.
  7. [7] Kriegmair M.. Slepp H., Steinbach P.. Lumper W.. Ehsan A.. Siepp H. Ci., Rick K., Kniichel R.. Baumgartner.R., Hofstetter A.: Fluorescence cystoscopy following intravesical instillation of 5 aminolevulinic acid: a new procedure with high sensitivity for (/election of hardly visible urothelial neoplasias. Urol. Int. 1995,55,190-196.
  8. 18] Kriegmair M., Waidelich R., Lumper W., Ebsan A,. Baumgartner R., 1-lofsleller A.: Integral pliotodynamic treatment ofrefractory superficial bladder cancer, i\\\'. Urol. 1995,154,1339-1341.
  9. [9] Kriegmair M„ Baumgartner R., Kniichel R., Slepp H., 1 lofsliidter F., Hofstetter A.: Detection of early bladder cancer by 5a-ami-nolevulinic acid induced porphyrin fluorescence. J. Urol. 1996. 155,105-110.
  10. [10] Manyak M. J.; Practical aspects ofphotodynamic therapy for superficial bladdercarcinoma. Tech. Urol. 1995,1.84-93.
  11. [11] Marcus S. L., Sobel R. S„ Golub A. L„ Can-oil R. [.., Lundahl S., Shulman D. G.: Pliotodynamic therapy (POT) and photodiagnosis (PD) using endogenous plioioseiisitization induced by 5a-ami nolevulinic acid (ALA): current clinical and development status. J. Clin. Laser. Med. Surg. 1996.14.59-66.
  12. [12/ Moan J.. Beth O., Gaullicr J. M.. StokkeT., Sieen H. B., Ma, L. W., Berg. K...\\\' Protoporphyrin IX accumulation in cells treated with 5a-amiitolevulinic acid: dependence on cell density, cell size and cell cycle. InL J. Cancer 1998,75.134-139.
  13. [13] Waidelich R., Hofstetter A.. Slepp H.. Baumgartner R.. Weninger L., Kriegmair M.: Early clinical experience with 5a-aminolevuli-nic acid for the pliotodynamic therapy of upper tract urothelial tumors.}. Ural 1998. 159.401-404.
  14. [14] Xiao 7... MillerG. G., McCallum T. J.. Brown K. M., Lown J. W., Tulip J., Moore R. 13.: Biodistrihulion of Photofrin II and 5a-aminolevidinic acid induced protoporphyrin IX in normal rat bladder and bladder tumor models: implications for pliotodynamic therapy. Photochem. Photobiol. 1998.67, 573-583.


Marek Lipiński
Klinika Urologii I Ch AM w Łodzi ul. Pabianicka 62. 93-513 Łódź