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Resection with Photodynamic Diagnosis (PDD)

Products for PDD

Products for PDD

Non-muscle invasive bladder cancer is usually treated with a minimally invasive surgical procedure the bipolar transurethral resection in saline of the bladder (TURis-B). The addition of photodynamic diagnosis (PDD) to the procedure allows greatly improved detection of tumours.

PDD allows improved detection of flat lesions such as CIS and satellite lesions and can improve the definition of tumour borders. It benefits in particular the diagnosis of carcinoma in situ (CIS), which are usually flat lesions and are often not clearly identified under white light.

Prior to the procedure, a photosensitive marker is introduced transurethrally into the bladder, where it is converted to protoporphyrin IX. This pigment is then absorbed by healthy cells, yet remains accumulated in tumour cells. The resectoscope is introduced to the bladder. Under blue excitation illumination, the accumulated pigment emits red fluorescence, while normal bladder tissue remains blue. A yellow-light filter in the scope specially designed for PDD enhances the red fluorescence, giving excellent contrast.

Tumours detected by PDD may then be resected immediately using bipolar TURis-B. Upon ignition in saline, a plasma pocket is formed and therewith the tumour cells resected accurately and smoothly. Bipolar resection improves patient safety as no current flows through the patient and it reduces the risk of TUR syndrome and accidental obturator nerve stimulation.

Olympus supplies all the equipment necessary for a successful TURis-B with PDD. The VISERA ELITE imaging platform is equipped with a PDD function, allowing switching from white light to PDD at the touch of a button. Olympus’ OES Pro resectoscopes are available with the yellow-light compensation filter necessary to emphasise red-light fluorescence during PDD. Olympus also supplies a full range of TURis electrodes allowing seamless diagnosis and resection in a single procedure.

Blue filter in light source

To perform PDD observation, a dedicated photosensitive marker (5-ALA or HAL) is first instilled in the bladder. About 90 to 120 minutes later, the endoscopic examination is started.

Blue filter in light source

To perform PDD observation, a dedicated photosensitive marker (5-ALA or HAL) is first instilled in the bladder. About 90 to 120 minutes later, the endoscopic examination is started.

Yellow filter in scope

For video observation, the special camera head equipped with CCD with compensation filter that emphasises red light to increase contrast and sharpness in PDD images is required.

Yellow filter in scope

For video observation, the special camera head equipped with CCD with compensation filter that emphasises red light to increase contrast and sharpness in PDD images is required.

Yellow filter in scope

For video observation, the special camera head equipped with CCD with compensation filter that emphasises red light to increase contrast and sharpness in PDD images is required.

Blue filter in light source

To perform PDD observation, a dedicated photosensitive marker (5-ALA or HAL) is first instilled in the bladder. About 90 to 120 minutes later, the endoscopic examination is started.

History (left: white light | right: PDD)

A slightly uneven surface in white light cystoscopy that was intensely fluorescent in blue light was collected by cold-cup biopsy.

History (left: white light | right: PDD)

A slightly uneven surface in white light cystoscopy that was intensely fluorescent in blue light was collected by cold-cup biopsy.

Pathology (cold-cup biopsy)

Low power is evocative of the erosive form of carcinoma in situ as the urothelial layer is detached (arrowhead) or denuded (*).

Pathology (cold-cup biopsy)

Low power is evocative of the erosive form of carcinoma in situ as the urothelial layer is detached (arrowhead) or denuded (*).

PDD detects more patients with bladder cancer

Compared with standard white light cystoscopy, PDD detected 30% more patients with bladder cancer in one study (Jichlinski P et al. J Urol 2003;170:226-9.)

PDD improves the detection of CIS lesions

PDD detected 28% more CIS lesions than standard cystoscopy in a multicentre study (Schmidbauer J et al. J Urol 2004;171:135-8.)

PDD reduces residual tumour rates

The improved rate of detection of tumours with PDD led to a 59% reduction in residual tumours in one study (Riedl CR et al. J Urol 2001;165:1121-3.)

PDD improves recurrence-free survival and quality of life

Compared with detection by white light, patients whose bladder cancer was detected by PDD had improved recurrence-free survival and quality of life (Denzinger S et al. BJU Int 2008;101:566-9.)

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