5-aminolaevulinic acid-induced fluorescence cystoscopy during transurethral resection reduces the risk of recurrence in stage Ta/T1 bladder cancer

BJU Int. 2005 Oct;96(6):798-802. doi: 10.1111/j.1464-410X.2004.05715.x.


Objective: To assess the influence of 5-aminolaevulinic acid-induced fluorescence cystoscopy (FC) during transurethral resection (TUR) on the recurrence rate and the length of tumour-free interval in stage Ta/T1 transitional cell carcinoma (TCC) of the urinary bladder.

Patients and methods: In all, 122 patients with primary or recurrent stage Ta/T1 bladder TCC treated with TUR were enrolled in a prospective randomized study. In group A the TUR was performed with standard white-light endoscopy, and in group B with FC. The patients were followed using standard cystoscopy and urinary cytology. The recurrence-free interval was evaluated in whole groups, for single and multiple, and for primary and recurrent tumours separately.

Results: At the time of the first cystoscopy (10-15 weeks after TUR) tumour recurrence was detected in 23 of 62 patients (37%) in group A, but only in five of 60 patients (8%) in group B. The recurrence-free survival rates in group A were 39% and 28% after 12 and 24 months, compared to 66% and 40% respectively in group B (P = 0.008, log-rank test). In separate analyses, the recurrence-free survival rates were significantly higher using FC in multiple (P = 0.001) and in recurrent (P = 0.02) tumours. In solitary and primary tumours the median time to recurrence was also longer in group B, but the difference was not statistically significant.

Conclusion: 5-aminolaevulinic acid-induced FC during TUR reduces the recurrence rate in stage Ta/T1 bladder TCC. The most significant benefit is in patients with multiple and recurrent tumours.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aminolevulinic Acid*
  • Carcinoma, Transitional Cell / diagnosis*
  • Carcinoma, Transitional Cell / surgery
  • Cystoscopy / methods*
  • Disease-Free Survival
  • Female
  • Fluorescence
  • Humans
  • Male
  • Neoplasm Recurrence, Local / prevention & control
  • Photosensitizing Agents*
  • Prospective Studies
  • Risk Factors
  • Urinary Bladder Neoplasms / diagnosis*
  • Urinary Bladder Neoplasms / surgery


  • Photosensitizing Agents
  • Aminolevulinic Acid