The aim of this study was to evaluate if Hexaminolevulinate (Hexvix) fluorescence cystoscopy improved bladder tumour identification and management and whether repeated episodes of Hexvix incurred further benefits. Methods: All patients undergoing Hexvix cystoscopy at a District General Hospital between October 2008 and October 2014 were incorporated. Data collected and analysed included reason for Hexvix, repeats of Hexvix, findings at white-light and Hexvix cystoscopies, complications,

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... y and outcomes. Results: Sixty cases of Hexvix cystoscopies were performed on forty-nine patients. Nine had repeats and two had a further third episode. No complications were reported. Reasons for Hexvix included thirty-eight (63%) for surveillance/abnormal flexible cystoscopy, ten (16.7%) post-BCG treatment and ten (16.7%) persistently abnormal urine cytology. Twentytwo (36.7%) confirmed bladder carcinoma. Twenty-two cases documented white-light and Hexvix findings. Twelve described no abnormalities with white-light which fluoresced using Hexvix. Of these, five confirmed malignancy. Three of nine patients confirmed bladder malignancies after the initial Hexvix. Subsequent repeats detected no abnormalities. Conclusion: Hexvix improved the detection of bladder tumours, particularly in CIS/pT1G3 tumours. It highlighted areas of malignancies not visualised by white-light cystoscopy. No additional benefits were seen from repeating Hexvix cystoscopies.