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Objectives: To describe the introduction and evaluate efficacy of photodynamic diagnosis with Hexvix for detecting tumours and abnormal mucosal lesions during transurethral resection of bladder tumour (TURBT). Subjects and methods: Prospective study of consecutive eligible patients who underwent TURBT with aid of Hexvix-guided cystoscopy in a single District General Hospital (NHS Trust in England). The participants selected were patients suspected to have bladder cancer or enlisted to undergo TURBT. The main outcome measures were the number of tumours or abnormal mucosal lesions that were missed by white light cystoscopy (WLC) but detected by Hexvix, blue light cystoscopy (BLC). Results: A total of 63 patients (39 males and 24 females; mean age 74 years; age range, 35–88 years) met study criteria. 15 were excluded: in 6 intra-vesical Hexvix was retained for 1 h; of the remaining 53 patients, 5 were excluded for technical reason, failure of fluorescence. Seventy five lesions were detected in the remaining 48 patients. Of these, 51 (68%) were detected by WLC and BLC both. BLC detected additional 24 (32%) lesions that were missed by WLC. Of these lesions, 15 (20%) were cancer and 9 (12%) were inflammation or dysplasia. Conclusion: BLC with Hexvix was easily introduced into a Bladder cancer management protocol and well tolerated by most patients. BLC increased diagnostic accuracy of cystoscopy during TURBT, although some of the lesions it detected were false positive.