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      Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA — update 2018

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          Blue light cystoscopy (BLC) with hexaminolevulinate (HAL) during transurethral resection of bladder cancer improves detection of non-muscle-invasive bladder cancer (NMIBC) and reduces recurrence rates. Flexible BLC was approved by the FDA in 2018 for use in the surveillance setting and was demonstrated to improve detection. Results of a phase III prospective multicentre study of blue light flexible cystoscopy (BLFC) in surveillance of intermediate-risk and high-risk NMIBC showed that 20.6% of malignancies were identified only by BLFC. Improved detection rates in the surveillance setting are anticipated to lead to improved clinical outcomes by reducing future recurrences and earlier identification of tumours that are unresponsive to therapy. Thus, BLFC has a role in surveillance cystoscopy, and determining which patients will benefit from BLFC and optimal and cost-effective ways of incorporating this technology into surveillance cystoscopy must be developed.


          In this Consensus Statement, experts in the field detail the current evidence regarding blue light flexible cystoscopy for bladder cancer surveillance and make recommendations regarding its use on the basis of conclusions arrived at during the panel discussions at a consensus meeting.

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          Most cited references 35

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          Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends.

          Bladder cancer has become a common cancer globally, with an estimated 430 000 new cases diagnosed in 2012.
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            EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016.

            The European Association of Urology (EAU) panel on Non-muscle-invasive Bladder Cancer (NMIBC) released an updated version of the guidelines on Non-muscle-invasive Bladder Cancer.
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              Bladder cancer.

              Bladder cancer is a heterogeneous disease, with 70% of patients presenting with superficial tumours, which tend to recur but are generally not life threatening, and 30% presenting as muscle-invasive disease associated with a high risk of death from distant metastases. The main presenting symptom of all bladder cancers is painless haematuria, and the diagnosis is established by urinary cytology and transurethral tumour resection. Intravesical treatment is used for carcinoma in situ and other high grade non-muscle-invasive tumours. The standard of care for muscle-invasive disease is radical cystoprostatectomy, and several types of urinary diversions are offered to patients, with quality of life as an important consideration. Bladder preservation with transurethral tumour resection, radiation, and chemotherapy can in some cases be equally curative. Several chemotherapeutic agents have proven to be useful as neoadjuvant or adjuvant treatment and in patients with metastatic disease. We discuss bladder preserving approaches, combination chemotherapy including new agents, targeted therapies, and advances in molecular biology.

                Author and article information

                Nat Rev Urol
                Nat Rev Urol
                Nature Reviews. Urology
                Nature Publishing Group UK (London )
                24 April 2019
                24 April 2019
                : 16
                : 6
                : 377-386
                [1 ]ISNI 0000 0000 9482 7121, GRID grid.267313.2, UT Southwestern Medical Center, ; Dallas, TX USA
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                [4 ]ISNI 0000 0004 1936 8753, GRID grid.137628.9, Department of Urology, , New York University School of Medicine, ; New York, NY USA
                [5 ]ISNI 0000 0004 0420 5521, GRID grid.413890.7, Genitourinary Surgery Section, , Michael E. DeBakey VA Medical Center, ; Houston, TX USA
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                [7 ]ISNI 0000000419368657, GRID grid.17635.36, Department of Urology, , University of Minnesota, ; Minneapolis, MN USA
                [8 ]ISNI 0000 0004 1936 9457, GRID grid.8993.b, Department of Urology, Institute of Surgical Sciences, , Uppsala University, ; Uppsala, Sweden
                [9 ]ISNI 0000 0001 2285 2675, GRID grid.239585.0, Department of Urology, , Columbia University Medical Center, ; New York City, NY USA
                [10 ]ISNI 0000 0004 1936 8294, GRID grid.214572.7, Department of Urology, , University of Iowa, ; Iowa City, IA USA
                [11 ]ISNI 0000 0004 0447 0018, GRID grid.266900.b, Department of Urology, , University of Oklahoma, ; Oklahoma City, OK USA
                [12 ]ISNI 0000 0001 2285 7943, GRID grid.261331.4, Department of Urology, , Ohio State University, ; Columbus, OH USA
                [13 ]ISNI 0000 0001 2264 7217, GRID grid.152326.1, Department of Urologic Surgery, , Vanderbilt University, ; Nashville, TX USA
                [14 ]ISNI 0000 0001 2152 0791, GRID grid.240283.f, Department of Urology, , Montefiore Medical Center, ; New York, NY USA
                [15 ]ISNI 0000 0001 1034 1720, GRID grid.410711.2, Department of Urology, , University of North Carolina, ; Chapel Hill, NC USA
                [16 ]ISNI 0000 0004 1936 7822, GRID grid.170205.1, Department of Urology, , University of Chicago, ; Chicago, IL USA
                [17 ]ISNI 0000 0001 2166 5843, GRID grid.265008.9, Department of Urology, , Sidney Kimmel Medical College at Thomas Jefferson University, ; Philadelphia, PA USA
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                © The Authors 2019

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                Consensus Statement
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                © Springer Nature Limited 2019

                bladder cancer, endoscopy, cancer imaging


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