The past, present and future of cystoscopy: the fusion of cystoscopy and novel imaging technology.

Non-muscle-invasive bladder cancer is a frequent disease with many recurrences, making it a labour-intensive and costly disease. In part, these frequent recurrences are due to inadequate diagnosis. Diagnostic reference standards to date are urinary cytology and cysto-urethroscopy, but both standards have significant limitations. Urinary cytology is specific, but the sensitivity, especially for low-grade tumours, is very low. Moreover, the reproducibility of cytology is low. However, cysto-urethroscopy misses many tumours, especially flat carcinoma in situ, causing flaws in the initial diagnosis and treatment, i.e. transurethral resection. Therefore, new techniques are necessary to improve the detection of bladder cancer. Here we review the advantage and disadvantage of conventional white-light and fluorescence-based cystoscopy, and discuss novel endoscopic imaging techniques that are in the clinical and preclinical stage of development.