Hexaminolevulinate is equal to 5-aminolevulinic acid concerning residual tumor and recurrence rate following photodynamic diagnostic assisted transurethral resection of bladder tumors

Urology. 2009 Dec;74(6):1282-6. doi: 10.1016/j.urology.2009.06.088. Epub 2009 Oct 12.


Objectives: To compare the outcomes of 5-aminolaevulinic acid (ALA) vs hexaminolaevulinate (HEX) vs white light (WL) transurethral resection of bladder tumors (TURB) to assess transferability of ALA findings to HEX. Extending WL-TURB with photodynamic diagnostic improves outcome. Two fluorescent agents have been commonly used for this. Although numerous and specific data exist on the older substance ALA, considerably less are available on hex, the only agent approved however. To date no such report has been published.

Methods: By random generator, each 200 patients with non-muscle-invasive bladder cancer having undergone TURB with WL, ALA or HEX were selected from our institutional data bank. Residual tumor in control TURB (RT) and recurrence-free survival (RFS) were assessed.

Results: Complete follow-up data were available on 142 WL, 139 ALA, and 135 HEX patients. Median duration of follow-up was 24 months. RT was 33% in WL, 15% in ALA, and 9% in hex, respectively. RFS at 3 years was 67% in WL, 80% in ALA, and 82% in hex, respectively. RT was significantly reduced in ALA and HEX vs WL (P < .001) and RFS prolonged (P < .01). There were no significant differences between ALA and HEX in RT and RFS, respectively (RT: P = .37; RFS: P = .72).

Conclusions: In the present retrospective series, ALA and HEX were found to be significantly superior to WL. No differences between ALA and HEX were demonstrated. Even from a careful perspective both fluorescent agents seem to be comparable. Thus, ALA-based findings seem to be transferable on the approved agent HEX.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aminolevulinic Acid / analogs & derivatives*
  • Carbon Radioisotopes*
  • Cystectomy / methods
  • Cystoscopy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm, Residual
  • Photosensitizing Agents*
  • Retrospective Studies
  • Urethra
  • Urinary Bladder Neoplasms / diagnosis*
  • Urinary Bladder Neoplasms / epidemiology
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / surgery*


  • Carbon Radioisotopes
  • Photosensitizing Agents
  • Aminolevulinic Acid
  • 5-aminolevulinic acid hexyl ester