The Role of White Light Enhancements and AI-Based Cystoscopy

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How to cite: Lotan Y. The Role of White Light Enhancements and AI-Based Cystoscopy. Grand Rounds in Urology. December 2025. Accessed Oct 2026. https://grandroundsinurology.com/the-role-of-white-light-enhancements-and-ai-based-cystoscopy/

Summary

Yair Lotan, MD, Professor of Urology, Chief of Urologic Oncology, and Jane and John Justin Distinguished Chair in Urology, University of Texas Southwestern Medical Center, Dallas, Texas, reviews enhanced cystoscopic imaging technologies and emerging artificial intelligence applications aimed at improving tumor detection and management in non–muscle-invasive bladder cancer.

Dr. Lotan notes that transurethral resection of bladder tumor quality remains central to outcomes in non-muscle-invasive bladder cancer. Residual tumor and missed carcinoma in situ contribute to recurrence and progression. Standard white light cystoscopy has recognized limitations in detecting flat and subtle lesions.

Blue light cystoscopy uses intravesical hexaminolevulinate, which accumulates in malignant cells and fluoresces under blue light. Dr. Lotan notes that enhanced imaging improves the detection of additional tumors compared with white light alone. He cites data showing an approximately 20 percent increase in overall detection and a 34 percent increase in the detection rate for carcinoma in situ. Enhanced cystoscopy may identify lesions that would otherwise be missed during surveillance or operative evaluation.

Narrow band imaging enhances visualization of vascular patterns without requiring intravesical instillation. This technology can be toggled during cystoscopy and provides improved contrast between tumor and normal urothelium. Dr. Lotan discusses practical considerations, including platform availability and workflow differences between technologies.

Emerging optical technologies include confocal laser endomicroscopy, optical coherence tomography, and spectroscopy-based approaches. Artificial intelligence systems are being developed to support real-time tumor detection, classification, and border delineation. Early data suggest high specificity, though sensitivity remains variable and continued refinement is required.

Dr. Lotan emphasizes that enhanced visualization technologies improve tumor detection and may influence management decisions. Artificial intelligence–based cystoscopy represents an evolving adjunct that requires further validation before routine clinical integration.

About the 2025 International Bladder Cancer Update Expert Forum™

The International Bladder Cancer Update (IBCU) Expert Forum™ is a physician-led conference bringing together urologists, urologic oncologists, and other healthcare professionals involved in the treatment and diagnosis of bladder cancer. The conference offers interactive expert lectures, panel discussions, and case presentations offers a dynamic look at the latest advancements and state-of-the-art technologies in the field of bladder cancer management. The 2025 IBCU Expert Forum™ encompassed the management of muscle-invasive, non-muscle invasive, and metastatic bladder cancer; upper-tract disease; as well as giving a specific focus on radical vs bladder sparing surgical approaches.

ABOUT THE AUTHOR

Yair Lotan, MD

Yair Lotan, MD, is a Professor of Urology, Chief of Urologic Oncology, and holder of the Jane and John Justin Distinguished Chair in Urology, in Honor of Claus G. Roehrborn, MD at University of Texas Southwestern Medical Center. He is also the Medical Director of the Urology Clinic at UT Southwestern and Parkland Health and Hospital System. Dr. Lotan is known nationally for his research on urine markers and molecular markers, which help determine which patients are at higher risk for recurrent cancer.

About The Author

Yair Lotan, MD

Yair Lotan, MD, is a Professor of Urology, Chief of Urologic Oncology, and holder of the Jane and John Justin Distinguished Chair in Urology, in Honor of Claus G. Roehrborn, MD at University of Texas Southwestern Medical Center. He is also the Medical Director of the Urology Clinic at UT Southwestern and Parkland Health and Hospital System. Dr. Lotan is known nationally for his research on urine markers and molecular markers, which help determine which patients are at higher risk for recurrent cancer. Dr. Lotan graduated with high honors from the University of Texas at Austin and Baylor College of Medicine in Houston. He trained in general surgery and urology at UT Southwestern and joined the faculty in 2003. Dr. Lotan is the co-chair of the Harold C. Simmons Comprehensive Cancer Center disease oriented team for urologic cancers. He is also a member of UT Southwestern’s Clinical Research Planning Group and the Tissue Bank Steering Committee and Cancer Committee. Dr. Lotan is a frequent guest speaker at medical conferences around the world and belongs to numerous professional organizations, including the American Urological Association, the Society of Urologic Oncology, and the Bladder Cancer Advocacy Network. He is also involved in health economics research, which evaluates the cost-effectiveness of surgery and cancer prevention. He has published hundreds of research articles and several book chapters on urologic care and procedures, and he serves as editorial reviewer for medical periodicals such as the Journal of Urology, European Urology, Cancer, Urologic Oncology, and the British Journal of Urology International.

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