Related Experiment Video
Updated: May 19, 2026
Probe-based Confocal Laser Endomicroscopy of the Urinary Tract: The Technique
Published on: January 10, 2013
Hexaminolevulinate-induced fluorescence versus white light during transurethral resection of noninvasive bladder
Theocharis Karaolides1, Andreas Skolarikos, Andreas Bourdoumis
1Anticancer Hospital Agios Sabas, Athens, Greece. charikara@gmail.com
Objective:
To evaluate the effect of hexaminolevulinate (HAL)-induced fluorescence during resection of noninvasive bladder cancer on tumor recurrence compared with resection under white light.
Methods:
Between 2008 and 2010, 102 consecutive patients with suspected bladder cancer were randomized to undergo transurethral resection with either conventional white light or combination of white light and HAL-induced fluorescence. Difference in tumor recurrence rate and recurrence-free survival between the 2 groups was evaluated. Subgroup analysis on recurrence-free survival was performed for different tumor parameters.
Results:
Cystoscopy at 3 months revealed tumor recurrence in 6 of 45 (13.3%) patients of the white light group compared with only 1 of 41 patients of the HAL group (2.4%) (P < .001). The recurrence-free rates in white light patients at 12 and 18 months were 56.3% and 50.6%, respectively, compared with 91% and 82.5% in HAL patients (P = .0006). In subgroup analyses, recurrence-free survival was similar between the 2 groups when solitary tumors were treated (P = .3525). However, the HAL group had a favorable recurrence-free survival compared with the white light group when multifocal tumors (P < .001), primary tumors (P = .0237), recurrent tumors (P = .0189), nonaggressive (papillary urothelial neoplasm of low malignant potential and low grade) tumors (P = .0204), or aggressive (high grade and carcinoma in situ) tumors (P = .0134) were treated.
Conclusion:
HAL significantly aids resection of non-muscle-invasive bladder cancer with the result of reduction in tumor recurrence rates.
