Fluorescence Cystoscopy and Optimized MMC in Recurrent Bladder Cancer (FinnBladder 9)

Inclusion Criteria: \- Primary papillary bladder cancer at high risk for further recurrence as defined as follows: Number of primary tumors ≥2, OR Size of solitary primary tumor ≥ 3 cm, OR Recurrent papillary tumors * Histologically proven Ta bladder cancer * Histological grade 1-2 (WHO 1973 grading system) or papillary urothelial neoplasm of low malignant potential (PUNLMP) or low grade (WHO 2004 grading system) bladder cancer * Written informed consent is required from every eligible patient Exclusion Criteria: * Grade 3 tumors (WHO 1973 grading system), or high grade tumors (WHO 2004 grading system) * CIS (carcinoma in situ) * Suspicion or evidence of papillary tumors or CIS of the upper urinary tract * Non-TCC (transitional cell carcinoma, i.e. urothelial carcinoma) bladder cancer * Suspicion or previous history of the patient not tolerating intravesical instillations * Known allergy to MMC or hexaminolevulinate (HAL, Hexvix®) * Urethral stricture, stone disease, chronic urinary tract infection or any other urological condition that may compromise study participation (as judged by treating physician) * Pregnancy or lactating patient * Other non-cured malignancy (excepting skin basalioma or cancer in situ of the cervix uteri or any other malignancy in remission ≥5 years) * Age \< 18 years * Expected survival time less than one year * Expected poor compliance (e.g. some severe psychiatric disorders, antisocial behaviour, or dementia)