Hexaminolevulinate blue light cystoscopy: a review of its use in the diagnosis of bladder cancer.

Hexaminolevulinate (HAL) is an ester derivative of 5-aminolevulinate, and is used in conjunction with blue light (fluorescence) cystoscopy (BLC) to detect bladder cancer. In various studies, HAL-BLC was generally a better detection method than the gold standard method of white light cystoscopy (WLC), as assessed by endpoints including additional lesions (at both the lesion and patient levels) not detected by WLC, higher detection rates, and more complete treatment decisions as a result of improved detection. HAL-BLC in addition to WLC was associated with reduced tumor recurrence rates compared with WLC alone in randomized trials with up to 2 years' follow-up. HAL-BLC was generally well tolerated, and the most common adverse events (i.e. hematuria, dysuria, and bladder spasm) were also the most common adverse events in the WLC alone group, and were expected as a result of the resection procedure. Although its impact on disease progression and survival rates is not yet known, HAL-BLC is a valuable addition to WLC for the diagnosis of bladder cancer in patients who are suitable candidates for its use.