Can experience of blue light cystoscopy improve a surgeon's white light resection? Data from the PHOTO trial

You have accessJournal of UrologyCME1 Apr 2023PD13-02 CAN EXPERIENCE OF BLUE LIGHT CYSTOSCOPY IMPROVE A SURGEON'S WHITE LIGHT RESECTION? DATA FROM THE PHOTO TRIAL Paul Gravestock, Thenmalar Vadiveloo, Rebecca Lewis, Anne Duncan, Steven Penegar, Emma Clark, Ge Yu, Paramananthan Mariappan, Joanne Cresswell, John Mcgrath, James N’dow, Ghulam Nabi, Hugh Mostafid, John Kelly, Craig Ramsay, Henry Lazarowicz, Angela Allan, Matthew Breckons, Karen Campbell, Louise Campbell, Andy Feber, Alison Mcdonald, John Norrie, Giovany Orozco-Leal, Stephen Rice, Zafer Tandogdu, Ernest Taylor, Laura Wilson, Luke Vale, Graeme Maclennan, Emma Hall, and Rakesh Heer Paul GravestockPaul Gravestock More articles by this author , Thenmalar VadivelooThenmalar Vadiveloo More articles by this author , Rebecca LewisRebecca Lewis More articles by this author , Anne DuncanAnne Duncan More articles by this author , Steven PenegarSteven Penegar More articles by this author , Emma ClarkEmma Clark More articles by this author , Ge YuGe Yu More articles by this author , Paramananthan MariappanParamananthan Mariappan More articles by this author , Joanne CresswellJoanne Cresswell More articles by this author , John McgrathJohn Mcgrath More articles by this author , James N’dowJames N’dow More articles by this author , Ghulam NabiGhulam Nabi More articles by this author , Hugh MostafidHugh Mostafid More articles by this author , John KellyJohn Kelly More articles by this author , Craig RamsayCraig Ramsay More articles by this author , Henry LazarowiczHenry Lazarowicz More articles by this author , Angela AllanAngela Allan More articles by this author , Matthew BreckonsMatthew Breckons More articles by this author , Karen CampbellKaren Campbell More articles by this author , Louise CampbellLouise Campbell More articles by this author , Andy FeberAndy Feber More articles by this author , Alison McdonaldAlison Mcdonald More articles by this author , John NorrieJohn Norrie More articles by this author , Giovany Orozco-LealGiovany Orozco-Leal More articles by this author , Stephen RiceStephen Rice More articles by this author , Zafer TandogduZafer Tandogdu More articles by this author , Ernest TaylorErnest Taylor More articles by this author , Laura WilsonLaura Wilson More articles by this author , Luke ValeLuke Vale More articles by this author , Graeme MaclennanGraeme Maclennan More articles by this author , Emma HallEmma Hall More articles by this author , and Rakesh HeerRakesh Heer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Photodynamic diagnosis (PDD) is a method of improving cystoscopic detection of bladder lesions. Whilst there is good evidence to support improved diagnosis over white light (WL), this has not clearly translated into a reduction in recurrence rates when PDD is used at transurethral resection of the tumour (TURBT). To date there has been mixed evidence with a recent Cochrane review concluding that there may be benefit to PDD TURBT, though there was a low certainty of evidence. The PHOTO trial looked to study the efficacy of PDD by means of a large pragmatic randomised trial. However whilst recurrence rates were reduced in the PDD cohort initially, over a longer duration of follow up there was no benefit of PDD seen. The objective of this further analysis is to explore the possible causes for the pattern observed, looking at whether the learning curve associated with PDD may have led to this observation and the implications this may have on clinical practice. METHODS: The PHOTO trial was conducted across 22 hospitals in the United Kingdom. It enrolled patients with new diagnoses of intermediate/high risk bladder cancer who were randomised to have their initial resection performed using WL or PDD. Further follow up and adjuvant treatment was as per established guidelines. RESULTS: 418 patients were included within the intention to treat analysis in the PHOTO trial. Recurrence rates at 3 years showed no significant difference between the PDD and WL Cohort, there was however an initial reduction in recurrence rates seen in the PDD cohort prior to 20 months. Further analyses showed that surgeon experience of PDD was significant. Where resections were undertaken by surgeons who were experienced in PDD (previously performed more than 40 PDD procedures) there was a lower risk of recurrence than those performed by surgeons who had undertaken less than 10 cases using PDD; HR 0.60 (95% CI: 0.40 – 0.92); p=0.019. This was irrespective of whether WL or PDD was used during the resection. Furthermore recurrence rates were unaffected by grade of operating surgeon when consultant was compared to registrar/non consultant career grade: HR 0.94 (95% CI: 0.67-1.33); p=0.736). CONCLUSIONS: Data from the PHOTO trial has shown that surgeons with more experience of PDD have better outcomes in both their PDD and WL resections. Our hypothesis is that experience of PDD improves resection technique and as such should be considered as a training tool for all urologists undertaking TURBT regularly. Source of Funding: The PHOTO trial was funded by the National Institute for Health Research (NIHR) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e405 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Gravestock More articles by this author Thenmalar Vadiveloo More articles by this author Rebecca Lewis More articles by this author Anne Duncan More articles by this author Steven Penegar More articles by this author Emma Clark More articles by this author Ge Yu More articles by this author Paramananthan Mariappan More articles by this author Joanne Cresswell More articles by this author John Mcgrath More articles by this author James N’dow More articles by this author Ghulam Nabi More articles by this author Hugh Mostafid More articles by this author John Kelly More articles by this author Craig Ramsay More articles by this author Henry Lazarowicz More articles by this author Angela Allan More articles by this author Matthew Breckons More articles by this author Karen Campbell More articles by this author Louise Campbell More articles by this author Andy Feber More articles by this author Alison Mcdonald More articles by this author John Norrie More articles by this author Giovany Orozco-Leal More articles by this author Stephen Rice More articles by this author Zafer Tandogdu More articles by this author Ernest Taylor More articles by this author Laura Wilson More articles by this author Luke Vale More articles by this author Graeme Maclennan More articles by this author Emma Hall More articles by this author Rakesh Heer More articles by this author Expand All Advertisement PDF downloadLoading ...