Hexyl aminolevulinate fluorescence cystoscopy in bladder cancer.
Although bladder cancer occurs frequently, early diagnosis and complete removal of malignant lesions usually lead to good clinical outcomes. In the USA, white light cystoscopy (WLC) is commonly used for bladder cancer diagnosis and guidance of the surgical resection. However, with WLC malignant and precancerous lesions may be missed, resulting in a high rate of disease recurrence. Monitoring for and treating these recurrences carry high direct and indirect costs. Because hexyl aminolevulinate (HAL; 5-ALA-hexylester) fluorescence cystoscopy has greater sensitivity than WLC, especially for detecting early stage lesions, and its use provides more complete resection and lower disease recurrence, it has been recommended in European clinical guidelines. This article reports our own HAL experiences and first time recurrence data, describes how HAL was developed, provides key clinical trial results, and discusses how HAL, which has revolutionized fluorescence cystoscopy and bladder cancer care in Europe, may ultimately revolutionize bladder cancer care in the USA.
Sievert
Karl-Dietrich
KD
Department for Urology, University of Tuebingen, Germany. karl.sievert@med.uni-tuebingen.de
Kruck
Stephan
S
D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D002986:Clinical Trials as Topic; D003558:Cystoscopy / Q000379:methods; D005456:Fluorescent Dyes; D006801:Humans; D009364:Neoplasm Recurrence, Local; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000601:surgery
D005456:Fluorescent Dyes; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester