title: Role of hexaminolevulinate-guided fluorescence cystoscopy in bladder cancer: critical analysis of the latest data and European guidance.
abstract: OBJECTIVE
  Hexaminolevulinate (HAL) is an optical imaging agent used with fluorescence cystoscopy (FC) for the detection of non-muscle-invasive bladder cancer (NMIBC). Guidelines from the European Association of Urology (EAU) and a recent, more detailed European expert consensus statement agree that HAL-FC has a role in improving detection of NMIBC and provide recommendations on situations for its use. Since the publication of the EAU guidelines and the European consensus statement, new evidence on the efficacy of HAL-FC in reducing recurrence of NMIBC, compared with white light cystoscopy (WLC), have been published.
  
  
  METHODS
  To consider whether these new trials have an impact on the expert guidelines and on clinical practice (e.g. supporting existing recommendations or providing evidence for a change or expansion of practice), a group of bladder cancer experts from Denmark, Finland, Norway and Sweden met to address the following questions: What is the relevance of the new data on HAL-FC for clinical practice in managing NMIBC? What impact do the new data have on European guidelines? How could HAL-FC be used in clinical practice? and What further information on HAL-FC is required to optimize the management of NMIBC?
  
  
  CONCLUSIONS
  This article reports the outcomes of the discussion at the Nordic expert panel meeting, concluding that, in line with European guidance, HAL-FC has an important role in the initial detection of NMIBC and for follow-up of patients to assess tumour recurrence after WLC. It provides practical advice, with an algorithm on the use of this diagnostic procedure for urologists managing NMIBC.
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. per-uno.malmstrom@surgsci.uu.se
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.forename: Magnus
authors.initials: M
authors.lastname: Grabe
authors.forename: Erik Skaaheim
authors.initials: ES
authors.lastname: Haug
authors.forename: Pekka
authors.initials: P
authors.lastname: Hellström
authors.forename: Gregers G
authors.initials: GG
authors.lastname: Hermann
authors.forename: Karin
authors.initials: K
authors.lastname: Mogensen
authors.forename: Mika
authors.initials: M
authors.lastname: Raitanen
authors.forename: Rolf
authors.initials: R
authors.lastname: Wahlqvist
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D032921:Consensus; D003558:Cystoscopy / Q000379:methods*; D005060:Europe; D005453:Fluorescence; D006801:Humans; D017319:Photosensitizing Agents; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester