title: Fluorescence detection of bladder tumors with 5-amino-levulinic acid.
abstract: BACKGROUND
  Preliminary data suggest that photodiagnosis by fluorescence detection of protoporphyrin IX, a biosynthetic product of the photosensitizer 5-amino-levulinic acid (ALA), is superior to conventional cystoscopy in bladder tumor detection.
  
  
  METHODS
  We instilled 1.5 g of ALA into the bladders of 52 patients with suspect bladder lesions 1 to 4 hours prior to transurethral resection or biopsy. Red fluorescence was induced by violet-blue light (wavelength 380-450 nm).
  
  
  RESULTS
  In 13 patients (25%), significant tumors were detected by fluorescence that were missed on conventional cystoscopy. In the present series, ALA photodetection had a sensitivity of 94.6% (compared with 76% for cystoscopy) and a specificity of 43%.
  
  
  CONCLUSIONS
  Fluorescence diagnosis with ALA may become a standard procedure for bladder tumor detection and resection, especially in endoscopically difficult situations (carcinoma in situ, multifocal tumors, multiple prior resections, or previous drug instillation therapy).
authors.affiliation: Department of Urology and Ludwig-Boltzmann-Institute for Urology and Andrology, Municipal Hospital Lainz, Vienna, Austria. ric@khl.uro.magwien.gv.at
authors.forename: C R
authors.initials: CR
authors.lastname: Riedl
authors.forename: E
authors.initials: E
authors.lastname: Plas
authors.forename: H
authors.initials: H
authors.lastname: Pflüger
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid; D003558:Cystoscopy; D005453:Fluorescence; D006801:Humans; D008875:Middle Aged; D017319:Photosensitizing Agents; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000473:pathology*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid