We are able to report the first upper tract blue light cystoscopy, and with it, diagnose upper tract CIS. Regular white light examination of the upper tract appeared to be normal, while blue light examination revealed red, porphyrin fluorescence of the distal ureteral wall suspicious for CIS. Biopsies of this area under blue light led to diagnosis of upper tract disease that otherwise would have been omitted. Patient was offered, and agreed to undergo, upper tract dual laser ablation and pelvicalyceal BCG. His three month follow up surveillance ureteroscopy is pending.
4. Conclusion
Photodynamic surgery using blue light with Cysview uniquely added to the diagnostic and therapeutic treatment of insidious upper tract urothelial carcinoma in a patient with a wide, patulous ureteral orifice. To our knowledge, this is the first instance of using blue light to evaluate the upper tract for UTUC. The patientâs pathology was confirmed by biopsy to be CIS, and evaluation with white light alone likely would have understaged the patient without the assistance of alternate wavelength diagnostics utilizing HAL.