103 Copyright © All rights are reserved by Omer Abdalla. Journal of Urology & Nephrology Studies Review Article The Clinical Impact of Hexylaminolevulinate-Blue Light Cystoscopy on Non-Muscle Invasive Bladder Cancer (NMIBC) Recurrence and Progression: A Critical Review Omer Abdalla 1,2,3 *, Seshadri Sriprasad 1,2 and Sanjeev Madaan 1,2 1 Dartford and Gravesham NHS Foundation Trust 2 Canterbury Christ Church University 3 Portsmouth Hospitals NHS Foundation Trust *Corresponding author: Omer Abdalla, Dartford and Gravesham NHS Foundation Trust, Canterbury Christ Church University, Portsmouth Hospitals NHS Foundation Trust, UK Received: May 14, 2019 Published: May 22, 2019 Introduction Bladder cancer (BC) is considered as the second most common urological malignancy [1] and the eighth most prevalent cancer in males and 14th most common malignancy in females [2]. In 2014 It was estimated that around 10,000 new BC cases were diagnosed in UK and accounted for 5,400 deaths which represents around 3% of all cancer death in UK [2]. The cost for bladder cancer diagnosis, treatment, and follow up for 5 years was £55.39 million, 63.6% (£35.25 million) of this amount was the cost for superficial bladder cancer. The mean cost per patient was higher for bladder cancer than for prostate cancer (£8349 vs. £7294) [3]. Non-muscle invasive bladder cancer (NMIBC) accounts for 75% of bladder cancer cases [3]. NMIBC includes Papillary lesions confined to bladder urothelium (Ta) or submucosa (T1) and Carcinoma in situ (CIS) [4,5]. NMIBC is associated with significant rate of recurrence up to 61% within 1 year and 78% within 5 years of resection, and moderate risk of progression to muscle invasive lesion in up to 17% at 1 year and up to 45% at 5 years [6]. This high percentage of recurrence and progression may be attributed to a number of factors such as; misdiagnosis of bladder cancer (false negative results), incomplete transurethral resection of the bladder tumour (TURBT) with resultant residual lesions or overlooked CIS lesions [7]. Therefore, robust diagnosis and lengthy follow up is of paramount importance, together with treatment costs it makes NMIBC the most costly neoplasm [8]. White light cystoscopy (WLC) remains the gold standard for superficial bladder cancer diagnosis, surveillance and follow up [4,9,10]. However, the sensitivity and specificity of WLC is not perfect particularly for CIS lesions, it was estimated that around 3.4% to 20.6 % of single lesions and 7.4% to 45.8% of multiple tumours are still overlooked by conventional WLC [9,11]. CIS has been estimated to have high risk 40-80% towards progression into muscle invasive cancer if not treated [12]. Therefore, improving diagnosis and adequate tumour resection (TURBT) cannot be overemphasized. Photodynamic diagnosis (PDD) by way of blue-light cystoscopy (BLC) is one of the new DOI: 10.32474/JUNS.2019.01.000123 ISSN: 2641-1687 Abstract The superficial bladder cancer is associated with high risk of recurrence and progression, necessitating lengthy follow up and repeated endoscopic treatments. White light cystoscopy (WLC) is the current gold standard for the diagnosis, treatment and surveillance, however the sensitivity and specificity isn’t perfect with risk of missing some tumours. A photodynamic diagnosis (PDD) using Blue-light cystoscopy is a novel concept proposed to overcome the WLC shortcomings. This critical review synthesizes the evidences on the effectiveness of Blue light cystoscopy (BLC) for the diagnosis of non-muscle invasive bladder cancer (NMIBC), and the impact of photodynamic diagnosis on the recurrence rate and progression of superficial bladder cancer.