Dr. Suzette Sutherland
speaker
230 appearances
4 recordings
1 series
first heard Aug 2024
last heard Jan 2025
Dr. Suzette Sutherland’s voice in public audio — every appearance, attributed to the second.
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Yeah. Can you refresh my memory? Is there a certain percentage? If it's mixed, is there a certain percentage of high grade to put them into the high grade category, like 5% or is it any high grade?
Well, I mean, that's obviously a very important junction then whether a patient is deemed intermediate versus high, getting intravesical chemotherapy or intravesical BCG, and the risks associated with the intravesical therapy, right?
That clinical decision, taking out, you know, all of the objective things and looking at the patient, having the patient help make that decision, what they're willing to do, it's not easy, right? And so, The more we have on the diagnostic end of things to point our fingers towards a high risk situation to tell us to do the intravascular therapy.
I mean, it obviously makes our job somewhat easier to some degree, right? Because that decision making process is out of it, the judgment part. But also, I think for the patient to accept that. doing intravesical therapy. It's not an easy thing. You do this all the time, right?
This isn't my specialty, but I do have some bladder cancer patients that are women in my practice, and it's never an easy thing for those women to undergo that and some of the hardships associated with the symptoms thereafter and so on and so forth that they go through, right? So this really would help, you know, make that diagnosis. I found some information on the sensitivity.
the accuracy, right? Looking at what's seen through the eye and then what's seen histologically. And with white light, the accuracy is 76% compared to blue light, 91%. And then combination, white plus blue, 98.5%. Now, clearly that comes from, I'm sure, one conglomerate study of looking at things. But still, the difference there is really poignant.
And why do you say that? Is that more for our learning purposes? So then we can go back and say, this is what it looked like in white, and now I see it on blue. So ergo, next time I'm going to know that white light, little distal I didn't think was important, is important, or is there more to it?
Because if we think real practically, when we, you know, you put the cyst view in, it They sit there for an hour and it colors the bladder. We'll get into the workflow in a minute, but it colors the bladder. So when you take them to the OR there and put in the scope, it's already all colored. You've lost your white, your absolute white light.
Or do you mean, well, I guess, no, you can still see everything looks still the same on white light or are there differences on white light with the SysView in?
Okay. That was really the big question. I think sometimes I hear people wonder if it ruins your ability to get a good white light look, but you're saying no, you still get a good white light look and then you turn on the blue light imaging and you get your blue light. Right. Yes. Got it. So let's talk about the workflow a little bit.
Sometimes people think there's too much fuss and muss and can I really do this? And I'm at an institution where it's done quite easily. I think it's just important to get a good workflow going. to be able to do this efficiently and have some trained staff that understand the importance of what you're doing.
So why don't you walk us through what you do when you have a handful of cases maybe stacked or how you make it work for you?
So that was a question I had just to make sure. So there's no other company that makes equipment that will be compatible for this. It's Storz.
It is interesting. Are there, you know, and it's part of the AUA guidelines and in such a strong way that there aren't more companies that have come down the pike to try and do the same thing, whether it's Olympus or other, you know, there are other imaging companies, right, that do optics. Are there newer ones coming down the pike that you're aware of? No, that kind of fits with this technology.
Yeah.
Yeah. And I'm sure as more time goes on, the quality of the imaging will only improve even more. I mean, that's where the technology is going and should go to enhance detection. So back to our workflow, I think we were stacking them in the front end, having your nurses educated, knowing so, you know, the nurse knows what to put in when and timing it and so on and so forth.
You mentioned if somebody can hold their bladder a sufficient amount of time, it's just an in and out catheter to put the CIS view in. But if you have somebody who says, no, I can't, then what do you do?
And it's helpful to put that in your standing orders and the algorithm so you don't get a phone call first thing in the morning always about it, right? You got it. It's an either or and the nurse decides which one to do. Right. So after your TURBT and the OR, you're done. You already said you cycle it through, then you do your TURBT.
Is there any post-op things that are additional because they did the cyst view?
Yeah. In what time span was that? Recommendation is about six weeks. And then, you know, let's talk a little bit about, too, upward migration of staging and the numbers around that and how blue light has, you know, sort of opened our eyes. We've had a little bit of this discussion, too, but not as much about just really that patients that have low risk
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