Blue light cystoscopy (BLC) using hexaminolevulinic acid has been shown to improve the detection of non-muscle invasive bladder (NMIBC) during cystoscopy and transurethral resection of bladder tumors. The product has been available in Europe (Hexvix®) for over a decade and in the US (Cysview®) is being used in select centers. In the video we demonstrate use of Cysview® for detection of different stages of urothelial carcinoma, its role in detection of cancer in the margin of previous resection and the efficacy of blue light cystoscopy in detecting concealed or tumor obscured ureteral orifices._x000D_


From April 2012 to May 2015, 252 patients underwent BLC and TURBT at our institution. Patients received Cysview® one hour prior to surgery. Clinicopathologic data were collected including intraoperative findings with white light (WL) and blue light (BL), lesion characteristics (flat versus papillary), location and size.


BLC with Cysview® is demonstrated in a number of challenging cases for the detection NMIBC as seen in figure 1 (top images: WL cystoscopy; bottom ones: same view under BL cystoscopy). The positive, bright red areas were biopsied and revealed urothelial carcinoma in each case. The top left image shows a papillary tumor on the right lateral wall with WL (HG T1). After turning on the blue light (bottom left), it also identified an additional flat lesion extending from the area of the tumor (CIS). The middle images show the bed of a previous resection site, negative on WL but positive with BL (CIS). Images on the right demonstrate a papillary lesion on the left hemi-trigone that was positive under BL as well (HG Ta). Additionally, we were able to identify tumor in the left ureteral orifice as well as a BL positive flat lesion surrounding the orifice (CIS on pathology). Another useful aspect of blue light cystoscopy is the ability to identify a urine jet (as a green hue) from the ureteral orifice without the use of methylene blue or indigo carmine. This feature is especially helpful in cases where the ureteral orifice cannot be easily identified secondary to anatomical variation or overlying tumor. _x000D_


Use of blue light cystoscopy with Cysview® can help with the detection of NMIBC as well as CIS in patients undergoing TURBT for bladder cancer. Other indications for using BLC is detecting tumoral involvement of previous resection margins and finding obscured ureteral orifices. _x000D_

Funding: None