Hexaminolevulinate Disease Interactions

Inflammation of the bladder may interfere with the diagnostic utility of hexaminolevulinate, which is an ester of the heme precursor, aminolevulinic acid. Following intravesical instillation of hexaminolevulinate, photoactive porphyrins are formed and accumulate intracellularly in bladder wall lesions. In humans, a higher degree of accumulation of porphyrins has been demonstrated in neoplastic or inflamed cells compared to normal bladder urothelium. As such, inflammation may lead to increased porphyrin buildup and higher risk of local toxicity upon illumination as well as false-positive fluorescence. Hexaminolevulinate should not be used in patients at high risk of bladder inflammation, such as those who received BCG immunotherapy or intravesical chemotherapy within the past 90 days. Widespread inflammation of the bladder should be excluded by cystoscopy before hexaminolevulinate is administered. If a widespread inflammation in the bladder becomes evident during white light inspection, the blue light inspection should be avoided.

The use of hexaminolevulinate is contraindicated in patients with gross hematuria. The presence of blood within the bladder may interfere with the detection of tissue fluorescence.

The use of hexaminolevulinate is contraindicated in patients with a diagnosis or a family history of porphyria. Hexaminolevulinate is an ester of the heme precursor, aminolevulinic acid. Following intravesical instillation, photoactive porphyrins are formed and accumulate intracellularly in bladder wall lesions.