PHOTODYNAMIC DIAGNOSIS (PDD) OF THE UPPER URINARY TRACT: IS IT REALLY FEASABLE?

OBIECTIVE We report our preliminary experìence in the field of photodynamic diagnosis of the upper urinary tract with flexible dedicated instruments and technical approach. METHODS: We reports 2 cases. a) 44yrs old man who underwent right nephroureterectomy for urothelial cancer 2003. In 2007 CT-scan showed a suspicious lesion in the PUJ but the ureteroscopy showing no recurrence. In ]uly 2010, a CT-scan showed a ureteral stone treated with ureterolithotrispy. After 2 months, he developed hydronephrosis with suspicious cytology. After a negative ureteroscopy, we performed photodynamic investigation. After HEXVIX° intravesical instillation, white/blu cystoscopy was performed. Then an occlusive ureteral balloon was inserted at the level of left PUJ and 25 ml of Hexvix solution was instilled. After 40 minutes in Trendelemburg position, a standard and blue light flexible ureteroscopy was performed. b) 73yrs old male underwent radical cistectomy and left nephroureterectomy. After demolition surgical time, fluorence ureteroscopy was performed in order to evaluate the remainder Kidney. RESULTS: 1 case. The white-light inspection detected a small calcification in the upper calyx of the kidney covering by a pho- tosensitising tissue. After removing the lesion, a biopsy was ta- ken. The histological examination showed a low-grade urothelial proliferation. 2 case. An extended lesion of the lower calyx was confirmed ana another unknown small lesion of the upper pole was detected suitable for conservative treatment. CONCLUSIONS: In difficult or complicated cases fluorescence investigation can provide a correct diagnosis of the upper urinary tract, thus reducing the percentage of late diagnosis and improving the standard of care.