Photodynamic diagnosis (PDD) for upper urinary tract transitional cell carcinoma (UT-TCC): Evolution of a new technique

Abstract

Transitional cell carcinoma of renal pelvis and ureter account was traditionally treated with nephroureterectomy. With the advent of rigid and flexible ureteroscopes endoscopic access to the ureter and renal pelvis for diagnosis and treatment has become a reality. We did fluorescence ureteroscopy using oral 5-ALA to diagnose upper tract urothelial tumours for four patients. Here we describe this technique and assess its feasibility to diagnose ureteric and renal pelvicalyceal tumours. A prospective pilot study was performed to assess the feasibility of PDD using oral 5-amino levulinic acid (ALA) for upper urinary tract tumours. Four patients underwent PDD guided flexible ureteroscopy of the upper urinary tract. Obvious exophytic tumour seen on white light was also seen as red fluorescence on blue light. All areas with red fluorescence were biopsied (including additional areas not seen on white light) and were confirmed to be transitional cell carcinoma. Photodynamic diagnosis using oral 5-ALA and subsequent treatment of upper tract urothelial tumours is safe and feasible with additional advantages of detecting lesions not visualised on conventional white light endoscopy.