Photodynamic Diagnosis-guided Ureteroscopic Surgery for Upper Urinary Tract Tumors

For upper urinary tract urothelial carcinoma (UTUC), the European Association of Urology and the National Comprehensive Cancer Network guidelines have recommended ureteroscopic surgery (URS) for cases with low-risk tumors (low-grade biopsy and cytology, <1.5–2 cm, unifocal, no invasion on imaging), and cases with bilateral tumors, a solitary kidney, or severe renal dysfunction. However, the 2-year recurrence rate after surgery is remarkably high, leading to the need for salvage radical nephroureterectomy. Furthermore, unlike robotic or laparoscopic surgery, the surgical procedure for URS has not been standardized due to the technical specificity of laser devices and ureteroscopes. Therefore, this procedure is performed only in limited facilities with extensive experience internationally. In this review, we introduce the current issues of URS for UTUC and the use of the photodynamic diagnosis-guided URS procedure, which we are implementing to overcome these challenges.