The high recurrence and progression rates in superficial bladder cancer are partially related to the deficiencies of the standard conventional diagnostic modalities. Therefore, innovative noninvasive and invasive detection devices have been studied during the last decade. New diagnostic urine markers are under intensive investigation in order to exclude the presence of urothelial cancer, but the value of all these tests is still insufficiently validated in diagnosis and follow-up. With the introduction of 5-amino-levulinic acid fluorescence endoscopy, the efficacy of the detection device has been significantly improved. Flat lesions such as carcinoma in situ can be completely detected besides exophytic tumors. This is of particular importance because the fate of the patient depends to an important extent on these tumor entities. Furthermore, first experimental results using imaging devices like optical coherence tomography and confocal laser scanning microscopy promise new powerful noninvasive tools for `optical sectioning' of the bladder.