title: Photodynamic diagnostic ureterorenoscopy: A valuable tool in the detection of upper urinary tract tumour.
abstract: BACKGROUND
  Photodynamic diagnosis increases the detection rate and hence decreases recurrence rates of urothelial cancer (UC) of the bladder. This technique has been implemented in the upper urinary tract and like in the bladder, has shown to increase the detection rate of urothelial lesions.
  
  
  OBJECTIVE
  To determine the sensitivity, specificity, and detection rates for photodynamic diagnostic flexible ureterorenoscopy (PDD-FURS) and white light ureterorenoscopy (WL-FURS). Design between 2009 and 2013, PDD-FURS was performed within 106 Upper urinary tract (UUT) Units (Mean age-72.6±9.5). Indications for the procedure included abnormal upper urinary tract on imaging, normal flexible cystoscopy with abnormal urine cytology, endoscopic treatment and follow-up of UUT UC. Oral 5-aminolevulinic acid was used as the photosensitizer administered 3-4 h pre-operatively.
  
  
  RESULTS
  48 lesions were detected, of which 95.8% (46/48) where visualised by PDD-FURS compared to 47.9% (23/48) shown by WL-FURS (P<0.0001). PDD-FURS detected significantly more carcinoma in situ (CIS) or dysplasia lesions than WL-FURS (93.75% (15/16) vs. 18.75% (3/16), respectively, (P=0.0006)). Furthermore, PDD-FURS detected significantly more UC lesions than WL-FURS (96.9% (31/32) vs. 62.5% (20/32) (P=0.007)). PDD-FURS was more sensitive (95.8; range: 85.7-99.5) than WL-FURS (53.5; range: 37.7-68.8) in detecting UUT-UC (P<0.0001). There was no difference (P=0.716) in the specificity between PDD-FURS (96.6; range: 88.1-99.6) and WL-FURS (95.2; range: 86.7-99).
  
  
  CONCLUSIONS
  Our results PDD-FURS with oral 5-ALA as photosensitizer suggest higher sensitivity and detection rate of urothelial tumours than WL-FURS, with a good safety profile. In our series, PDD-FURS enhanced the visualisation of flat lesions, such as CIS and dysplasia that otherwise would have been missed.
authors.affiliation: Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Ninewells Hospital & Medical School, Dundee, UK. Electronic address: g.kata@nhs.net.
authors.forename: Slawomir G
authors.initials: SG
authors.lastname: Kata
authors.affiliation: Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; Department of Urology, Royal Gwent Hospital, Newport, Wales, UK; Islamic Universities of Gaza, College of Medicine, Gaza, Palestine.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Aboumarzouk
authors.affiliation: Department of Urology, Gartnavel General Hospital, Glasgow, UK.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Zreik
authors.affiliation: Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; University Hospitals Southampton NHS Trust, Southampton, UK.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Somani
authors.affiliation: Department of Urology, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; Division of Imaging and Technology, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Nabi
authors.affiliation: The Scottish Photodynamic Therapy Centre, Ninewells Hospital & Medical School, Dundee, UK.
authors.forename: Ronald
authors.initials: R
authors.lastname: Buist
authors.affiliation: The Scottish Photodynamic Therapy Centre, Ninewells Hospital & Medical School, Dundee, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Goodman
authors.affiliation: Academic Urological Unit, Collegium Medicum, Jagiellonski University, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chlosta
authors.affiliation: Academic Urological Unit, Collegium Medicum, Jagiellonski University, Krakow, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Golabek
authors.affiliation: The Scottish Photodynamic Therapy Centre, Ninewells Hospital & Medical School, Dundee, UK; The Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Moseley
mesh_terms: D000284:Administration, Oral; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D007089:Image Enhancement / Q000379:methods; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D017319:Photosensitizing Agents / Q000008:administration & dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018666:Ureteroscopy / Q000379:methods*; D014523:Urethral Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid
keywords: 5-Aminolevulinic acid; Cystoscopy; Haematuria; Photodynamic diagnosis; Upper urinary tract tumour; Ureterorenoscopy