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A Cystoscopy is where a doctor looks into the bladder with a special telescope (Endoscope) called a Cystoscope

Cystoscopy is usually conducted with white light into a well irrigated bladder, however there is a case for using Flourescence Cystoscopy using products like Hexvix as produced by Photocure

A Cystoscopy is the process of introducing a specialised Endoscope into the Bladder allowing for direct visual inspection of the Urothelium. The Cystoscope is inserted through the Urethra into the bladder.

The endoscopy, also known as Cystoscopy, can be performed immediately after the Cystoscope has been introduced into the bladder and the pictures generated by the integrated camera are transmitted onto a nearby video screen, or by direct lens view without a screen. Cystoscopy can be performed with a local anaesthetic - usually for outpatients - or under general anaesthesia. Most Cystoscopes have extra tubes to guide other instruments for taking a biopsy of a bladder tumour or removal of superficial bladder tumours.

Standard white light cystoscopy is used in the diagnosis and monitoring of Bladder Cancer. Illumination for standard white light Cystoscopy is provided by special light sources integrated with the Cystoscope, which emit bright, white light. Cystoscopy-guided biopsy, i.e. Transurethral Resection (TUR) of suspicious lesions and areas, remains the standard procedure for verification of Bladder Cancer - including Carcinoma In Situ (CIS).[2]

Visual inspection using standard white light Cystoscopy is particularly good at detecting three-dimensional, i.e. papillary, lesions. However, detection of flat lesions - such as CIS -, which may be diffuse and indistinguishable from normal or nonspecific inflammatory-appearing mucosa, is limited when conventional standard white light Cystoscopy is being used.[2]

In order to assist the early and accurate diagnosis of Bladder Cancer, methods to improve Cystoscopy such as Fluorescence Cyctoscopy have been investigated. Intravesical porphyrin based Fluorescence Cystoscopy involves instilling a photosensitising agent - such as Hexvix - into the bladder. Hexvix induces preferential accumulation of fluorescent - photoactive - endogenous porphyrins in malignant cells as opposed to nonmalignant cells of urothelial origin. Under subsequent blue-light illumination, neoplastic lesions fluoresce red enabling visualisation of tumours.[2,3] Significant improvements in detection of malignant lesions with Hexvix cystoscopy compared to standard white light cystoscopy have been observed.[4] In addition, the capabilities of Hexvix in identifying CIS, which is very difficult to recognise under standard white light,[5] have also been noted. Overall, Hexvix Cystoscopy shows a statistically significant superiority over white light Cystoscopy regarding sensitivity for the detection of bladder lesions, which has been demonstrated in published studies.[3,4,5]

Hexvix Cystoscopy is a new diagnostic tool with improved sensitivity for detecting bladder tumours [over standard white light ]Cystoscopy], in particular CIS Tumours”, explained Professor Patrice Jichlinski, department of Urology, CHUV University-Hospital, Lausanne, Switzerland, lead investigator of a recent trial of Hexvix. Elaborating on the clinical results confirmed in several studies,[3,4,5] he added: “A statistically significant superiority of fluorescence cystoscopy over standard cystoscopy in the detection of CIS has been established in all published studies to date. Its high sensitivity and negative predictive value improves the diagnosis of malignancies and of CIS Tumours in particular. The cases missed by standard white light inspection were typically CIS lesions, confirming the superiority of Hexvix Cystoscopy in these cases. Tumour fluorescence is sparkling and well demarcated, whereas fluorescence from non-malignant tissue appears pinkish with an imprecise margin.”

Overall, the importance and superior efficacy of Hexvix Cystoscopy in comparison to white light Cystoscopy with respect to detection of CIS in particular is reflected in the European Association of Urology Guidelines on the Diagnosis and Treatment of Urothelial Carcinoma in Situ,[6] which clearly endorse the technique in its recommendation: “Fluorescence Cystoscopy should be considered because it has a greater sensitivity than white light Cystoscopy.”


1. Klem B. Hexvix cystoscopy - equipment needed. Hexvix Product Monograph:31.

2. Frampton JE, Plosker GL. Hexyl Aminolevulinate in the Detection of Bladder Cancer. Drugs 2006;66(4):571-8.

3. Schmidbauer J, Witjjes F, Schmeller N et al. Improved Detection of Urothelial Carcinoma In Situ with Hexaminolevulinate Fluorescence Cystoscopy. J Urol 2004;171:135-8.

4. Jocham D, Witjes F, Wagner S et al. Improved Detection and Treatment of Bladder Cancer Using Hexaminolevulinate Imaging: A Prospective, Phase III Multicenter Study. J Urol 2005;174:862-6.

5. Jichlinski P, Guillou L, Karlsen SJ et al. Hexyl Aminolevulinate Fluorescence Cystoscopy: A New Diagnostic Tool for the Photodiagnosis of Superficial Bladder Cancer - A Multicenter Study. J Urol 2003;170:226-9.

6. van der Meijden APM, Sylvester R, Oosterlink W et al. EAU Guidelines on the Diagnosis and Treatment of Urothelial Carcinoma in Situ. Eur Urol 2005;48:363-71.

© 2007 General Electric Company – All rights reserved. GE and GE Monogram are trademarks of General Electric Company.

Licensed from PhotoCure ASA. Hexvix is a registered trademark of PhotoCure ASA.


Although this procedure sounds as if it would be painfull it is not as the Urethra is very elastic and in a female approximately 4cms. it is considerably longer in a male!

Having had the procedure conducted on me many times I can assure you that unpleasant, unnatural and unusual best describe the feeling rather than painful and although I joke with others that it is as easy as shelling peas it is only afterwards it is like peeing shells! This lasts only, I find, for the first urination subsequent to the flexible Cystoscopy.

I would however stress that you best serve yourself and the doctor by relaxing thus minimising any chance of discomfort or possible damage.

User: Greg L-W.

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