Objective: To explain our use of photodynamic diagnostic ureterorenoscopy, we provide a detailed description of the choice of photosensitiser, equipment needed, a safety profile, and pointers on our technique. Technique: Patients are given oral 5-aminolaevulinic acid (5-ALA) as a photosensitiser 3-4 h pre-operatively, and by using a Xenon blue light source, an eyepiece which blocks light below 450 nm which is fitted onto the ureterorenoscope, we are able to conduct a thorough photodiagnosis of the upper urinary tract. Conclusion: Our technique of photodynamic diagnostic ureterorenoscopy has shown that the sensitivity, specificity and detection rates of upper urinary tract lesions can be significantly increased with the use of oral 5-ALA. Therefore, we provide a detailed explanation of the use of oral 5-ALA photosensitiser, indications and contraindications of the technique in addition to equipment used and potential complications of the procedures.

Keywords:
Photodynamic diagnosis, Ureterorenoscopy, Aminolaevulinic acid, Blue light, Upper urinary tract tumour, Bladder tumour
1.
Senger FL, Bottone JJ: Primary epithelial tumors of renal pelvis. Am J Surg 1937;37:57-67.
2.
Multescu R, Geavlete B, Georgescu D, Geavlete P: Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: a critical comparison. J Endourol 2010;24:17-21.
3.
Papatsoris AG, Kachrilas S, Howairis ME, Masood J, Buchholz N: Novel technologies in flexible ureterorenoscopy. Arab J Urol 2011;9:41-46.
4.
Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester R, Burger M, et al: European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol 2013;63:1059-1071.
5.
Green DA, Rink M, Xylinas E, Matin SF, Stenzl A, Roupret M, et al: Urothelial carcinoma of the bladder and the upper tract: disparate twins. J Urol 2013;189:1214-1221.
6.
Mowatt G, N'Dow J, Vale L, Nabi G, Boachie C, Cook JA, et al: Photodynamic diagnosis of bladder cancer compared with white light cystoscopy: systematic review and meta-analysis. Int J Technol Assess Health Care 2011;27:3-10.
7.
Aboumarzouk OM, Ahmad S, Kata SG, Moseley H: Accuracy of photodynamic diagnosis in the detection and follow-up of patients with upper urinary tract lesions: initial 3-year experience. Arab J Urol 2012;10:138-142.
8.
Aboumarzouk OM, Mains E, Moseley H, Kata SG: Diagnosis of upper urinary tract tumours: is photodynamic diagnosis assisted ureterorenoscopy required as an addition to modern imaging and ureterorenoscopy? Photodiagnosis Photodyn Ther 2013;10:127-133.
9.
Berlin NI, Neuberger A, Scott JJ: The metabolism of delta-aminolaevulic acid. 1. Normal pathways, studied with the aid of 15N. Biochem J 1956;64:80-90.
10.
Kemmner W, Wan K, Ruttinger S, Ebert B, Macdonald R, Klamm U, et al: Silencing of human ferrochelatase causes abundant protoporphyrin-IX accumulation in colon cancer. FASEB J 2008;22:500-509.
11.
Dalton JT, Yates CR, Yin D, Straughn A, Marcus SL, Golub AL, et al: Clinical pharmacokinetics of 5-aminolevulinic acid in healthy volunteers and patients at high risk for recurrent bladder cancer. J Pharmacol Exp Ther 2002;301:507-512.
12.
Wachowska M, Muchowicz A, Firczuk M, Gabrysiak M, Winiarska M, Wanczyk M, Bojarczuk K, Golab J: Aminolevulinic acid (ALA) is a prodrug in photodynamic therapy of cancer. Molecules 2011;16:4140-4164.
13.
Gronlund-Pakkanen S, Wahlfors J, Makinen K, Pakkanen TM, Talja M, Ala-Opas M, et al: The fluorescence biodistribution and kinetics of aminolevulinic acid induced protoporphyrin IX in the bladder of a rat model with orthotopic urothelial carcinoma. J Urol 2002;167:1848-1853.
14.
Inoue K, Fukuhara H, Shimamoto T, Kamada M, Iiyama T, Miyamura M, et al: Comparison between intravesical and oral administration of 5-aminolevulinic acid in the clinical benefit of photodynamic diagnosis for nonmuscle invasive bladder cancer. Cancer 2012;118:1062-1074.
15.
Johnson GB, Portela D, Grasso M: Advanced ureteroscopy: wireless and sheathless. J Endourol 2006;20:552-555.
16.
Parwani AV, Levi AW, Epstein JI, Ali SZ: Urinary bladder biopsy with denuded mucosa: denuding cystitis-cytopathologic correlates. Diagn Cytopathol 2004;30:297-300.
17.
Levi AW, Potter SR, Schoenberg MP, Epstein JI: Clinical significance of denuded urothelium in bladder biopsy. J Urol 2001;166:457-460.
18.
Moan J, Streckyte G, Bagdonas S, Bech O, Berg K: Photobleaching of protoporphyrin IX in cells incubated with 5-aminolevulinic acid. Int J Cancer 1997;70:90-97.
19.
Bondad J, Aboumarzouk OM, Moseley H, Kata SG: Oral 5-aminolevulinic acid induced photodynamic diagnostic ureterorenoscopy - does the blood pressure require monitoring? Photodiagnosis Photodyn Ther 2013;10:39-41.
© 2014 S. Karger AG, Basel
2014
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