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Application of 5-aminolauvulin acid (ALA) fluorescence allows to detect not only exophytic tumors of the bladder but also flat, small tumors-satellites and preneoplastic changes of the bladder. 175 biopsies were performed in 53 patients with suspected superficial tumor of the bladder. 3 hours before surgery all the patients were intravesically instilled 50 ml 3% ALA solution. Cystoscopy employed white and blue light. Visual registration of exophytic masses and red fluorescence of the suspected sites was registered and consequently compared to the histological findings. 96 of 100 sites with malignancy/dysplasia showed red fluorescence. In 13% patients cancer and mucosal dysplasia were detected only under the blue light and were missed by standard cystoscopy. Residual red fluorescence of the resection margins was observed in 41% patients after TUR. Sensitivity of ALA-fluorescent detection reached 96%, specificity 52%. ALA-induced fluorescent diagnosis is more effective than standard cystoscopy. It is most effective in diagnosis of dysplasias, carcinoma in situ, flat, small, multiple superficial tumors of the bladder during primary TUR.