[Enhanced endoscopic imaging for urothelial cancer]

The precise identification and detection of bladder tumours is a prerequisite for complete transurethral resection and, thus, the reduction of recurrence. White-light cystoscopy remains the gold standard and has been further improved by the introduction of digital HD techniques. New digital techniques such as narrow-band imaging (NBI) or the IMAGE 1 S-System have been introduced to better visualise suspicious areas. They are particularly valuable in the outpatient setting. However, fluorescence or photodynamic diagnostics (PDD) after instillation of hexaminolevulinic acid into the bladder is the only approach supported by good evidence. It is recommended by most guidelines in high-grade tumours or carcinoma in situ, while the value of NBI and the Image 1 S-System is under evaluation. Newer approaches include microscopic techniques such as optical coherence tomography, confocal laser endomicroscopy or molecular imaging. The combination of these methods with macroscopic imaging could be very promising.