{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:00:50Z","timestamp":1785862850906,"version":"3.56.0"},"reference-count":33,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>One pillar in treating non-muscle-invasive bladder cancer (NMIBC) is the complete and high-quality transurethral resection of the primary tumor (TURBT). However, even after a high-quality primary resection, the residual tumor risk is considerable, thus requiring a re-TURBT. Resections performed with the aid of a photodynamic diagnostics report improved recurrence-free survival rates and increased detection rates of carcinoma in situ (CIS). This monocentric retrospective study reports on patients treated with an extended TURBT procedure using conventional white-light cystoscopy or photodynamic diagnostics (PDD). Only patients undergoing a TURBT resection for their primary tumor were included in the statistical analysis. Recurrence-free survival and overall survival were the clinical endpoints. Mann\u2013Whitney U tests and chi-squared tests were used for descriptive intergroup comparisons. The associations with overall survival and recurrence-free survival were determined by univariate and multivariate analyses. The test results were considered significant when p was &lt; 0.05. In comparison to conventional white-light cystoscopy, PDD increased the detection rates of CIS (p = 0.004) and tumor multifocality (p = 0.005) and led to reduced residual tumor incidence at the primary resection site (p &lt; 0.001). Likewise, tumor recurrence rates were reduced in the PDD cohort (p &lt; 0.001). Patient age and the presence of residual tumor at the primary resection site were identified as independent predictors of overall survival. For recurrence-free survival, only the PDD resection method was an independent predictor (HR = 0.43; p &lt; 0.001). In summary, we demonstrated that the utilization of PDD techniques was associated with improved detection rates of CIS and multifocal tumors and with reduced recurrence rates. The extended resection protocol allowed us to determine that PDD resections lead to a reduced residual tumor rate at the initial resection site. This residual tumor state at the resection site, determined by extended TURBT, became an independent predictor of long-term survival. On the other hand, the PDD technique was confirmed as the only independent predictor of recurrence-free survival.<\/jats:p>","DOI":"10.3390\/life12050641","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T11:45:55Z","timestamp":1650973555000},"page":"641","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reduced Recurrence Rates Are Associated with Photodynamic Diagnostics Compared to White Light after Extended Transurethral Resection of Bladder Tumors"],"prefix":"10.3390","volume":"12","author":[{"given":"Alexander","family":"Marquardt","sequence":"first","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Richterstetter","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9077-1727","authenticated-orcid":false,"given":"Helge","family":"Taubert","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"},{"name":"Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arndt","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany"},{"name":"Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 8-10, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Wullich","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"},{"name":"Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6772-508X","authenticated-orcid":false,"given":"Verena","family":"Lieb","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"},{"name":"Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bellut","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"},{"name":"Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Wach","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"},{"name":"Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Apel","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universit\u00e4t Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany"},{"name":"Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.eururo.2012.07.033","article-title":"Epidemiology and risk factors of urothelial bladder cancer","volume":"63","author":"Burger","year":"2013","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.eururo.2019.08.016","article-title":"European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)\u20142019 Update","volume":"76","author":"Babjuk","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.juro.2016.06.049","article-title":"Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA\/SUO Guideline","volume":"196","author":"Chang","year":"2016","journal-title":"J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1159\/000503734","article-title":"Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis","volume":"104","author":"Yang","year":"2020","journal-title":"Urol. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1111\/j.1464-410X.2011.10571.x","article-title":"Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: Validation across time and place and recommendation for benchmarking","volume":"109","author":"Mariappan","year":"2012","journal-title":"BJU Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.eururo.2009.05.047","article-title":"Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience","volume":"57","author":"Mariappan","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"40.e17","DOI":"10.1016\/j.urolonc.2013.04.009","article-title":"Presence of detrusor muscle in bladder tumor specimens\u2014Predictors and effect on outcome as a measure of resection quality","volume":"32","author":"Shoshany","year":"2014","journal-title":"Urol. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.eururo.2005.12.031","article-title":"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","volume":"49","author":"Sylvester","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.eururo.2020.12.033","article-title":"European Association of Urology (EAU) Prognostic Factor Risk Groups for Non-muscle-invasive Bladder Cancer (NMIBC) Incorporating the WHO 2004\/2016 and WHO 1973 Classification Systems for Grade: An Update from the EAU NMIBC Guidelines Panel","volume":"79","author":"Sylvester","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/S0302-2838(02)00068-4","article-title":"Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: A combined analysis of seven EORTC studies","volume":"41","author":"Brausi","year":"2002","journal-title":"Eur. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/bju.13102","article-title":"Significance of the interval between first and second transurethral resection on recurrence and progression rates in patients with high-risk non-muscle-invasive bladder cancer treated with maintenance intravesical Bacillus Calmette-Gu\u00e9rin","volume":"116","author":"Bozlu","year":"2015","journal-title":"BJU Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/01.ju.0000070437.14275.e0","article-title":"Effect of routine repeat transurethral resection for superficial bladder cancer: A long-term observational study","volume":"170","author":"Grimm","year":"2003","journal-title":"J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1097\/MOU.0000000000000751","article-title":"Transurethral resection of bladder tumor and the need for re-transurethral resection of bladder tumor: Time to change our practice?","volume":"30","author":"Soria","year":"2020","journal-title":"Curr. Opin. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1111\/j.1464-410X.2010.09572.x","article-title":"Long-term follow-up of T1 high-grade bladder cancer after intravesical bacille Calmette-Gu\u00e9rin treatment","volume":"107","author":"Kakiashvili","year":"2011","journal-title":"BJU Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.eururo.2009.11.041","article-title":"Photodynamic diagnosis in non-muscle-invasive bladder cancer: A systematic review and cumulative analysis of prospective studies","volume":"57","author":"Kausch","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.urology.2009.06.088","article-title":"Hexaminolevulinate is equal to 5-aminolevulinic acid concerning residual tumor and recurrence rate following photodynamic diagnostic assisted transurethral resection of bladder tumors","volume":"74","author":"Burger","year":"2009","journal-title":"Urology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1159\/000506653","article-title":"Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries","volume":"104","author":"Hein","year":"2020","journal-title":"Urol. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E76","DOI":"10.1111\/j.1464-410X.2011.10904.x","article-title":"The value of extended transurethral resection of bladder tumour (TURBT) in the treatment of bladder cancer","volume":"110","author":"Richterstetter","year":"2012","journal-title":"BJU Int."},{"key":"ref_20","first-page":"239","article-title":"A practical Application of a simple bootstrapping method for assessing predictors selected for epidemiologic risk models using automated variable selection","volume":"7","author":"Mannan","year":"2017","journal-title":"Int. J. Stat. Appl."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e784","DOI":"10.1016\/j.clgc.2019.04.014","article-title":"Quality Control Indicators for Transurethral Resection of Non-Muscle-Invasive Bladder Cancer","volume":"17","author":"Akand","year":"2019","journal-title":"Clin. Genitourin. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1007\/s00345-018-2581-3","article-title":"Novel nomograms to predict recurrence and progression in primary non-muscle-invasive bladder cancer: Validation of predictive efficacy in comparison with European Organization of Research and Treatment of Cancer scoring system","volume":"37","author":"Kim","year":"2019","journal-title":"World J. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e16426","DOI":"10.1097\/MD.0000000000016426","article-title":"Predicting recurrence of nonmuscle-invasive bladder cancer (Ta-T1): A study based on 477 patients","volume":"98","author":"Lu","year":"2019","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1007\/s10147-020-01654-5","article-title":"A new risk stratification model for intravesical recurrence, disease progression, and cancer-specific death in patients with non-muscle invasive bladder cancer: The J-NICE risk tables","volume":"25","author":"Miyake","year":"2020","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.eururo.2015.05.050","article-title":"Systematic Review and Individual Patient Data Meta-analysis of Randomized Trials Comparing a Single Immediate Instillation of Chemotherapy After Transurethral Resection with Transurethral Resection Alone in Patients with Stage pTa-pT1 Urothelial Carcinoma of the Bladder: Which Patients Benefit from the Instillation?","volume":"69","author":"Sylvester","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1111\/iju.14372","article-title":"Impact of second transurethral resection on recurrence in patients with high-grade Ta bladder cancer","volume":"27","author":"Taoka","year":"2020","journal-title":"Int. J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1017\/S0266462310001364","article-title":"Photodynamic diagnosis of bladder cancer compared with white light cystoscopy: Systematic review and meta-analysis","volume":"27","author":"Mowatt","year":"2011","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/j.juro.2010.06.148","article-title":"Hexaminolevulinate guided fluorescence cystoscopy reduces recurrence in patients with nonmuscle invasive bladder cancer","volume":"184","author":"Stenzl","year":"2010","journal-title":"J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1007\/s00345-017-2077-6","article-title":"\u2018Real-life experience\u2019: Recurrence rate at 3 years with Hexvix(\u00ae) photodynamic diagnosis-assisted TURBT compared with good quality white light TURBT in new NMIBC-a prospective controlled study","volume":"35","author":"Gallagher","year":"2017","journal-title":"World J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.euros.2021.06.011","article-title":"Time to Turn on the Blue Lights: A Systematic Review and Meta-analysis of Photodynamic Diagnosis for Bladder Cancer","volume":"31","author":"Veeratterapillay","year":"2021","journal-title":"Eur. Urol. Open. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4081\/aiua.2020.1.17","article-title":"Hexaminolevulinate blue light cystoscopy (Hal) assisted transurethral resection of the bladder tumour vs white light transurethral resection of the bladder tumour in non-muscle invasive bladder cancer (NMIBC): A retrospective analysis","volume":"92","author":"Capece","year":"2020","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Miyake, M., Nishimura, N., Nakai, Y., Fujii, T., Owari, T., Hori, S., Morizawa, Y., Gotoh, D., Anai, S., and Torimoto, K. (2021). Photodynamic Diagnosis-Assisted Transurethral Resection Using Oral 5-Aminolevulinic Acid Decreases the Risk of Repeated Recurrence in Non-Muscle-Invasive Bladder Cancer: A Cumulative Incidence Analysis by the Person-Time Method. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020185"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s00345-016-1927-y","article-title":"Results of a prospective randomized study assessing the efficacy of fluorescent cystoscopy-assisted transurethral resection and single instillation of doxorubicin in patients with non-muscle-invasive bladder cancer","volume":"35","author":"Rolevich","year":"2017","journal-title":"World J. Urol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/5\/641\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:01:15Z","timestamp":1760137275000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/5\/641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,26]]},"references-count":33,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["life12050641"],"URL":"https:\/\/doi.org\/10.3390\/life12050641","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,26]]}}}