***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE As shown in various studies 5-aminolevulinic acid ( ALA ) induces fluorescence of malignant and dysplastic bladder tissue and increases tumor detection rates by about 20 % . However , data on the long-term benefits are sparse . Thus , the 5-year outcome data of a prospect i ve r and omized trial comparing patients who initially underwent bladder tumor resection ( TUR ) under st and ard white light  or with ALA induced fluorescence were evaluated . MATERIAL S AND METHODS A total of 115 patients with suspected superficial bladder cancer were r and omized to undergo st and ard or ALA assisted TUR . After the second look TUR at 6 weeks patients were followed for a median of 39 ( st and ard ) and 42 ( ALA ) months . RESULTS Median time to first recurrence was 5 months in the st and ard and 12 months in the ALA group . Recurrence-free survival was 25 % in the st and ard and 41 % in the ALA group . The recurrence rate at 2 , 12 , 36 and 60 months after initial TUR was 41 % , 61 % , 73 % and 75 % , and 16 % , 43 % , 59 % and 59 % in the white light and ALA groups , respectively . The total number of recurrences was 82 in the st and ard and 61 in the ALA group . Tumor progression occurred in 9 patients in the st and ard and 4 in the ALA group . Cost analysis suggests a considerable economical advantage of ALA fluorescence assisted TUR compared to the st and ard procedure . CONCLUSIONS The initial advantage of improved tumor detection and decreased recurrence rates by ALA fluorescence assisted TUR is maintained for years , and effectively reduces morbidity and costs in patients with superficial bladder tumors Abstract Objectives : A prospect i ve study was performed aim ing to evaluate the surgical efficacy , perioperative safety profile , diagnostic accuracy and medium term results of a multi-modal approach consisting in narrow b and imaging ( NBI ) cystoscopy and bipolar plasma vaporization ( BPV ) when compared to the st and ard protocol represented by white light cystoscopy ( WLC ) and transurethral resection of bladder tumors ( TURBT ) . Material s & Methods : A total of 260 patients with apparently at least one bladder tumor over 3 cm were included in the trial . In the first group , 130 patients underwent conventional and NBI cystoscopy followed by BPV  , while in a similar number of cases of the second arm , classical WLC and TURBT were applied . In all non-muscle invasive bladder tumors ’ ( NMIBT ) pathologically confirmed cases , st and ard monopolar Re-TUR was performed at 4 - 6 weeks after the initial intervention , followed by one year ’ BCG immunotherapy . The follow-up protocol included abdominal ultrasound , urinary cytology and WLC , performed every 3 months for a period of 2 years . Results : The obturator nerve stimulation , bladder wall perforation , mean hemoglobin level drop , postoperative bleeding , catheterization period and hospital stay were significantly reduced for the plasma vaporization technique by comparison to conventional resection . Concerning tumoral detection , the present data confirmed the NBI superiority when compared to st and ard WLC regardless of tumor stage ( 95.3 % vs. 65.1 % for CIS , 93.3 % vs. 82.2 % for pTa , 97.4 % vs. 94 % for pT1 , 95 % vs. 84.2 % overall ) . During st and ard Re-TUR the overall ( 6.3 % versus 17.4 % ) and primary site ( 3.6 % versus 12.8 % ) residual tumors ’ rates were significantly lower for the NBI-BPV group . The 1 ( 7.2 % versus 18.3 % ) and 2 ( 11.5 % versus 25.8 % ) years ’ recurrence rates were substantially lower for the combined approach . Conclusions : NBI cystoscopy significantly improved diagnostic accuracy , while bipolar technology showed a higher surgical efficiency , lower morbidity and faster postoperative recovery . The combined technique offered a reduced rate of residual tumors at Re-TUR , both globally as well as for orthotopic tumors . Substantially lower recurrence rates were found at 1 and 2 years among the NBI-BPV cases Purpose To investigate whether narrow b and imaging (NBI)-assisted transurethral resection ( TUR ) ( NBI-TUR ) has an impact on non-muscle invasive bladder cancer ( NMIBC ) residual tumour rate compared to white light (WL)-assisted TUR ( WL-TUR ) . Methods Patients with NMIBC treated with either NBI- or WL-TUR  were compared in a frequency-matched index-control setting . During NBI-TUR , all suspicious lesions identified by either WL or NBI were resected . Index patients ( NBI-TUR , n = 40 ) were prospect ively recruited and control patients ( WL-TUR , n = 120 ) were retrospectively collected , whilst being blinded for their first follow-up (fFU)-status . Non-radical TUR cases , patients without evidence of urothelial carcinoma in the pathology specimen and those with isolated carcinoma in situ or muscle invasive disease were excluded . Matching was based on the risk of tumour recurrence defined by ( a ) the EORTC risk score for recurrence and ( b ) the administration or not of one single chemotherapeutic intravesical instillation immediately after TUR . All patients underwent routine follow-up with WL cystoscopy supplemented with cytology at 3 months or re-TUR in selected cases . The residual tumour rates at fFU ( RR-fFU ) of patients with NMIBC su bmi tted to either NBI- or WL-TUR were compared . Results Baseline patient and tumour characteristics were comparable between groups . The RR-fFU for WL- and NBI-TUR was 30.5 % ( 36 out of 118 patients ) and 15.0 % ( 6 out of 40 patients ) , respectively ( OR : 2.7 , one-sided 95 % CI : 1.2–6.1 ; P = 0.03 ) . Conclusion NBI-TUR decreases residual tumour rate significantly when compared to a matched cohort of WL-TUR OBJECTIVE To compare the differential effects of narrow b and imaging (NBI)-assisted holmium laser with transurethral resection on the 1-year recurrence rate of non-muscle invasive bladder cancer ( NMIBC ) , and to evaluate the clinical values of NBI-assisted holmium laser resection for NMIBC ( NBI-HoLRBt ) . METHODS During the period of February 2013 to February 2014 , 178 cases of NMIBC were r and omly divided into NBI-HoLRBt group and white light imaging ( WLI ) assisted transurethral resection of bladder tumor ( WLI-TURBt ) group . In NBI-HoLRBt , all suspicious lesion identified by either WLI or NBI were resected with WLI and in NBI mode for lesion only visible with NBI . At the end of the procedure , a NBI cystoscopic examination was performed to assess the margins of the resection areas and to identify eventual residual lesions . In WLI-TURBt group , only WLI and TURBt were applied . All patients underwent routine follow-up with WLI and NBI cystoscopy supplemented with cytology every 3 month . The recurrence risk of patients with NMIBC subjected to either NBI-HoLRBt or WLI-TURBt was compared at 3 and 12 month . RESULTS The 3-month and 1-year recurrence rate was 18.48 % ( 17/92 ) and 38.04 % ( 35/92 ) respectively in the WLI-TURBt group , it was 5.81 % ( 5/86 ) and 18.60 % ( 16/86 ) in the NBI-HoLRBt group ( both P<0.05 ) . In addition , the in situ recurrence rate was less in the NBI-HoLRBt than WLI-TURBt group ( 2.33 % vs 14.13 % , P<0.05 ) . CONCLUSION NBI-assisted holmium laser resection of bladder tumor can reduce the 3-month and 1-year recurrence risk of NMIBC and should be considered a valuable clinical therapeutic method for NMIBC Introduction : The objective of this study was to investigate the value of narrow-b and imaging ( NBI ) cystoscopy in the detection of patients with positive voided urine cytology ( VUC ) who have no evidence of disease after st and ard initial investigations . Patients and Methods : Between February 2009 and December 2010 , 12 patients with positive or suspicious VUC but no regular endoscopic evidence of cancer were investigated with NBI flexible cystoscopy . All the specimens were biopsied both under NBI and white light imaging ( WLI ) . R and om biopsies of bladder and prostatic urethra were performed in cases without suspect lesions . Results : Fourteen NBI cystoscopies were carried out in 12 patients . Non-muscle-invasive bladder cancer was diagnosed in 5 of 12 ( 42 % ) patients on the first NBI . One patient had carcinoma in situ diagnosed on repeat NBI 3 months later . The sensitivity and specificity in diagnosing unconfirmed positive VUC was 78 and 91 % for NBI vs. 50 and 80 % for WLI . Conclusions : NBI cystoscopy significantly improves detection of unconfirmed positive VUC over WLI . It should be carried out early in the investigation of such patients before r and om biopsies and ureteroscopy PURPOSE The role of a routine second transurethral resection in evaluating and managing bladder tumors is defined . MATERIAL S AND METHODS From January to October 1998 , 150 patients with new or recurrent bladder tumors underwent repeat transurethral resection  within 2 to 6 weeks after the initial resection , and the results , including the presence of residual tumor and tumor stage , were compared . RESULTS Of the 150 cases 36 ( 24 % ) had no and 114 ( 76 % ) had residual tumor on repeat transurethral resection . Of 96 cases with superficial ( Ta , Tis , T1 ) bladder tumors 72 ( 75 % ) had residual noninvasive tumor and 28 ( 29 % ) were up staged to invasive tumor . Among 54 patients with a muscle invasive tumor 12 ( 22 % ) had no residual tumor on repeat transurethral resection . Results of the second resection changed tumor treatment in 50 patients ( 33 % ) . CONCLUSIONS Many patients with bladder tumors have tumor present after an initial trans-urethral resection . Routine repeat resection is advised to control noninvasive tumors and to detect residual tumor invasion Recent advances in imaging technology may offer the ability to augment bladder cancer diagnosis , staging , and treatment . Fluorescence cystoscopy has been shown in numerous clinical studies to improve the detection of papillary and flat bladder lesions over conventional cystoscopy . Photosensitizing agents like aminolevulinic acid ( ALA ) and its derivative hexaminolevulinate ( HAL ) have undergone the most extensive investigation . Prospect i ve clinical trials have demonstrated improved diagnostic ability , enhanced tumor resection , and reduced tumor recurrence .  Optical coherence tomography is an emerging technology that shows promise in revealing subsurface information about bladder lesions in real-time , potentially leading to more accurate staging . Narrow-b and imaging may augment st and ard endoscopic tools by providing increased contrast between normal and abnormal tissue .  Virtual cystoscopy may allow non-invasive tumor diagnosis , treatment planning , and surveillance . We aim to provide an overview of the strengths and weaknesses of these imaging modalities and examine their potential impact on the diagnosis and management of bladder cancer PURPOSE We compared the outcomes of repeat transurethral resection plus intravesical mitomycin C with initial transurethral resection of bladder plus intravesical MMC in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder in terms of recurrence , progression and overall survival . MATERIAL S AND METHODS Of 148 newly diagnosed patients with T1 bladder cancer 142 were prospect ively r and omized in 2 groups between January 2001 and January 2005 . A total of 74 patients underwent second TURB  and received adjuvant MMC intravesically ( group 1 ) and 68 patients received adjuvant MMC following the initial TURB ( group 2 ) . All repeat TURB operations were performed 2 to 6 weeks following initial TURB . Patients with incomplete resection , Cis or muscle invasive disease were excluded from study . The first dose of mitomycin C ( 40 mg per week for a total of 8 weeks ) was instilled intravesically in all patients during the first 24 hours after the last surgery . RESULTS Mean followup was 31.5 months ( range 6 to 48 ) with no difference between the 2 groups . The rate of recurrence-free survival was 86.35 % ( SE 0.4 % ) , 77.67 % and  
    Output:
    
CONCLUSIONS Compared with WLI-TUR , NBI-TUR can reduce the recurrence risk of NMIBC .