[Transurethral bladder resection of non muscle invasive bladder cancer with Hexvix ®]

Bladder neoplasms are the second most frequent urological cancer after prostate cancer. Bladder neoplasms arise from urothelial tissue and can either be restricted within the Mucosa and the Lamina Propria (i.e., non muscle invasive bladder cancer [NMIBC]) or invade the Muscularis Propria (i.e., muscle invasive bladder cancer [MIBC]). An exhaustive transuretral resection of the bladder tumor (TURBT) has always been seen a surrogate of quality for the initial step of the treatment. Although a large majority of bladder tumors can be easily identified macroscopically, there are flat lesions (i.e., carcinoma in situ [CIS]), which are more difficult to diagnose. To improve detection of flat lesions, a fluorescence diagnosis under blue light has been proposed during cystoscopy. Photodynamic diagnosis is performed using blue light after preoperative intravesical instillation of hexaminolaevulinic acid (Hexvix(®)) to enhance visual contrast between urothelial cancer and normal tissue. Thus, the quality of TURBT appears to be improved in selected cases with a controversial benefit on the recurrence free survival. Due to its medico-economical constraints, worldwide spread of fluorescence cystoscopy is still limited and restricted to specific cases.