Recent advances in imaging technology may offer the ability to augment bladder cancer diagnosis, staging, and treatment. Fluorescence cystoscopy has been shown in numerous clinical studies to improve the detection of papillary and flat bladder lesions over conventional cystoscopy. Photosensitizing agents like aminolevulinic acid (ALA) and its derivative hexaminolevulinate (HAL) have undergone the most extensive investigation. Prospective clinical trials have demonstrated improved diagnostic ability, enhanced tumor resection, and reduced tumor recurrence. Optical coherence tomography is an emerging technology that shows promise in revealing subsurface information about bladder lesions in real-time, potentially leading to more accurate staging. Narrow-band imaging may augment standard endoscopic tools by providing increased contrast between normal and abnormal tissue. Virtual cystoscopy may allow non-invasive tumor diagnosis, treatment planning, and surveillance. We aim to provide an overview of the strengths and weaknesses of these imaging modalities and examine their potential impact on the diagnosis and management of bladder cancer.
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