Fluorescence cystoscopy and bladder surveillance.

Purpose Of Review: Update on new developments in the field of fluorescence cystoscopy.

Recent Findings: New agents are being studied to improve the accuracy of fluorescence cystoscopy. Hexyl-5-aminolevulinic acid is an ester form of 5-aminolevulinic acid with improved uptake by tumor cells. It has been shown to have higher specificity than 5-aminolevulinic acid and can possibly play a complementary role to standard cystoscopy. Hypericin is a promising new agent that has excellent sensitivity and specificity. The use of confocal microscopy to examine fluorescent tissue may help improve the accuracy.

Summary: The addition of newer agents to the armamentarium of fluorescence cystoscopy has great potential with promising results in improving the diagnostic accuracy of bladder cancer and in particular carcinoma in situ. These agents need to be studied in large randomized trials to prove that using these agents can facilitate early diagnosis and improved prognosis in patients with bladder cancer.