[Fluorescent endoscopy superior to white light endoscopy. Detecting cancers of the urinary bladder earlier]

5-aminolevulinic acid-induced fluorescence endoscopy (AFE) has enormously increased the effectiveness of early cancer detection. This was first shown for cancer of the bladder. After application of 5-aminolevulinic acid (5-ALA) endogenous protoporphyrin IX (PP IX) accumulates in tumor tissue. When such tissue is then irradiated with blue light, the neoplastic areas can be identified by red fluorescence and, in the case of the bladder, can be removed by transurethral resection (TUR) or laser coagulation in the same endoscopic session. The great advantage of this highly sensitive technique (95%) is to be seen in particular in the detection of flat urothelial neoplastic lesions--until recently a deficit in conventional white-light endoscopy. Initial investigations show that improved early detection and the reduction in the residual tumor rate lead to longer recurrence-free intervals.