{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T22:28:16Z","timestamp":1781130496019,"version":"3.54.1"},"reference-count":95,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>5-Aminolevulinic acid (5-ALA) induces tumor-selective accumulation of protoporphyrin IX (PpIX), enabling fluorescence-guided visualization of malignant tissue. In urologic oncology, the most established application is photodynamic diagnosis (PDD) during transurethral resection of non-muscle-invasive bladder cancer, in which fluorescence can identify occult carcinoma in situ and additional papillary lesions; however, specificity may decline in the presence of inflammation, recent instrumentation, or intravesical therapy. Renal applications are emerging: oral 5-ALA before partial nephrectomy can highlight some renal tumors, but fluorescence is often heterogeneous, can overlap with normal parenchyma, and is affected by histologic subtype, necrosis, blood attenuation, and device-dependent optics. Evidence in upper tract urothelial carcinoma and prostate cancer remains preliminary, with small cohorts and practical challenges in endoscopic or robotic workflows, alongside systemic adverse events such as hypotension and photosensitivity. This review synthesizes clinical and preclinical studies of 5-ALA-based fluorescence guidance across bladder, kidney, upper tract, and prostate malignancies, focusing on where the technology is ready for practice versus where it remains investigational. We discuss common pitfalls in interpretation and implementation and outline future directions, including quantitative fluorescence and spectroscopy, standardized dosing and imaging protocols, and prospective multicenter trials linking fluorescence guidance to residual disease, recurrence, margin status, and patient-centered outcomes.<\/jats:p>","DOI":"10.3390\/life16040546","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:48:41Z","timestamp":1774532921000},"page":"546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["5-Aminolevulinic Acid-Based Fluorescence Guidance in Urologic Oncology: Current Status, Pitfalls, and Future Directions"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0427-452X","authenticated-orcid":false,"given":"Takashi","family":"Matsuoka","sequence":"first","affiliation":[{"name":"Department of Urology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Igarashi","sequence":"additional","affiliation":[{"name":"Department of Urology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-6033","authenticated-orcid":false,"given":"Toshinari","family":"Yamasaki","sequence":"additional","affiliation":[{"name":"Department of Urology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutsushi","family":"Kawakita","sequence":"additional","affiliation":[{"name":"Department of Urology, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.juro.2016.06.049","article-title":"Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA\/SUO Guideline","volume":"196","author":"Chang","year":"2016","journal-title":"J. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.eururo.2021.08.010","article-title":"European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1, and Carcinoma In Situ)","volume":"81","author":"Babjuk","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1038\/bjc.1987.246","article-title":"Destruction of erythroleukaemic cells by photoactivation of endogenous porphyrins","volume":"56","author":"Malik","year":"1987","journal-title":"Br. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/1011-1344(90)85083-9","article-title":"Photodynamic therapy with endogenous protoporphyrin IX: Basic principles and present clinical experience","volume":"6","author":"Kennedy","year":"1990","journal-title":"J. Photochem. Photobiol. B"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S1470-2045(06)70665-9","article-title":"Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: A randomised controlled multicentre phase III trial","volume":"7","author":"Stummer","year":"2006","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S1011-1344(98)00102-X","article-title":"5-Aminolaevulinic acid-induced protoporphyrin IX accumulation in tissues: Pharmacokinetics after oral or intravenous administration","volume":"44","author":"Houtsmuller","year":"1998","journal-title":"J. Photochem. Photobiol. B"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.bcp.2005.10.019","article-title":"Mechanisms involved in delta-aminolevulinic acid (ALA)-induced photosensitivity of tumor cells: Relation of ferrochelatase and uptake of ALA to the accumulation of protoporphyrin","volume":"71","author":"Ohgari","year":"2005","journal-title":"Biochem. Pharmacol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.pdpdt.2013.02.001","article-title":"Expression levels of PEPT1 and ABCG2 play key roles in 5-aminolevulinic acid (ALA)-induced tumor-specific protoporphyrin IX (PpIX) accumulation in bladder cancer","volume":"10","author":"Hagiya","year":"2013","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hayashi, M., Fukuhara, H., Inoue, K., Shuin, T., Hagiya, Y., Nakajima, M., Tanaka, T., and Ogura, S. (2015). The effect of iron ion on the specificity of photodynamic therapy with 5-aminolevulinic acid. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122351"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"112017","DOI":"10.1016\/j.jphotobiol.2020.112017","article-title":"Evaluation of aminolevulinic acid-mediated protoporphyrin IX fluorescence and enhancement by ABCG2 inhibitors in renal cell carcinoma cells","volume":"211","author":"Howley","year":"2020","journal-title":"J. Photochem. Photobiol. B"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/php.13678","article-title":"Analysis of Renal Cell Carcinoma Cell Response to the Enhancement of 5-aminolevulinic Acid-mediated Protoporphyrin IX Fluorescence by Iron Chelator Deferoxamine","volume":"99","author":"Howley","year":"2023","journal-title":"Photochem. Photobiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1002\/cncr.26378","article-title":"Comparison between intravesical and oral administration of 5-aminolevulinic acid in the clinical benefit of photodynamic diagnosis for nonmuscle invasive bladder cancer","volume":"118","author":"Inoue","year":"2012","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.pdpdt.2015.03.008","article-title":"Oral 5-aminolevulinic acid mediated photodynamic diagnosis using fluorescence cystoscopy for non-muscle-invasive bladder cancer: A randomized, double-blind, multicentre phase II\/III study","volume":"12","author":"Inoue","year":"2015","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1111\/iju.13718","article-title":"Oral 5-aminolevulinic acid-mediated photodynamic diagnosis using fluorescence cystoscopy for non-muscle-invasive bladder cancer: A multicenter phase III study","volume":"25","author":"Nakai","year":"2018","journal-title":"Int. J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101999","DOI":"10.1016\/j.pdpdt.2020.101999","article-title":"Real-world experience with 5-aminolevulinic acid for the photodynamic diagnosis of bladder cancer: Diagnostic accuracy and safety","volume":"32","author":"Yamamoto","year":"2020","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102757","DOI":"10.1016\/j.pdpdt.2022.102757","article-title":"Real-world experience with 5-aminolevulinic acid for photodynamic diagnosis of bladder cancer (2nd report): Reduced bladder recurrence after PDD-TURBT","volume":"38","author":"Fukuhara","year":"2022","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102838","DOI":"10.1016\/j.pdpdt.2022.102838","article-title":"Photodynamic diagnosis-assisted transurethral resection using oral 5-aminolevulinic acid decreases residual cancer and improves recurrence-free survival in patients with non-muscle-invasive bladder cancer","volume":"38","author":"Taoka","year":"2022","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1111\/iju.15483","article-title":"Photodynamic diagnosis-assisted transurethral resection of bladder tumor for high-risk non-muscle invasive bladder cancer improves intravesical recurrence-free survival (BRIGHT study)","volume":"31","author":"Kawai","year":"2024","journal-title":"Int. J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jss.2008.12.027","article-title":"Surgical outcomes of fluorescence-guided laparoscopic partial nephrectomy using 5-aminolevulinic acid-induced protoporphyrin IX","volume":"154","author":"Hoda","year":"2009","journal-title":"J. Surg. Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Matsuoka, T., Suzuki, I., Suzuki, R., Fukunaga, A., Tohi, Y., Sugino, Y., Okada, T., and Kawakita, M. (2025). Fluorescence by 5-aminolevulinic acid-induced protoporphyrin IX varies in tumor and normal tissues during robot-assisted partial nephrectomy for renal cell carcinoma. BMC Surg., 25.","DOI":"10.1186\/s12893-025-02987-6"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.eururo.2024.07.027","article-title":"European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)-A Summary of the 2024 Guidelines Update","volume":"86","author":"Gontero","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/JU.0000000000003846","article-title":"Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA\/SUO Guideline: 2024 Amendment","volume":"211","author":"Holzbeierlein","year":"2024","journal-title":"J. Urol."},{"key":"ref_23","unstructured":"European Association of Urology (2025). EAU Guidelines on Non-Muscle-Invasive Bladder Cancer (TaT1 and CIS), EAU Guidelines Office."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"105\u2013109; discussion 109\u2013110","DOI":"10.1016\/S0022-5347(01)66559-5","article-title":"Detection of early bladder cancer by 5-aminolevulinic acid induced porphyrin fluorescence","volume":"155","author":"Kriegmair","year":"1996","journal-title":"J. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1002\/cncr.25523","article-title":"Detection and clinical outcome of urinary bladder cancer with 5-aminolevulinic acid-induced fluorescence cystoscopy: A multicenter randomized, double-blind, placebo-controlled trial","volume":"117","author":"Stenzl","year":"2011","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.juro.2007.03.028","article-title":"A comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of carcinoma in situ in patients with bladder cancer: A phase III, multicenter study","volume":"178","author":"Fradet","year":"2007","journal-title":"J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.juro.2007.03.034","article-title":"A phase III, multicenter comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of superficial papillary lesions in patients with bladder cancer","volume":"178","author":"Grossman","year":"2007","journal-title":"J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/j.juro.2010.06.148","article-title":"Hexaminolevulinate guided fluorescence cystoscopy reduces recurrence in patients with nonmuscle invasive bladder cancer","volume":"184","author":"Stenzl","year":"2010","journal-title":"J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.juro.2012.03.007","article-title":"Long-term decrease in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy","volume":"188","author":"Grossman","year":"2012","journal-title":"J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1007\/s00345-017-2077-6","article-title":"Real-life experience\u2019: Recurrence rate at 3 years with Hexvix(\u00ae) photodynamic diagnosis-assisted TURBT compared with good quality white light TURBT in new NMIBC-a prospective controlled study","volume":"35","author":"Gallagher","year":"2017","journal-title":"World J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/bju.15166","article-title":"Prospective evaluation of blue-light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer","volume":"127","author":"Lotan","year":"2021","journal-title":"BJU Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"382.e381","DOI":"10.1016\/j.urolonc.2022.04.012","article-title":"Safety of repeat blue light cystoscopy with hexaminolevulinate (HAL) in the management of bladder cancer: Results from a phase III, comparative, multi-center study","volume":"40","author":"Pohar","year":"2022","journal-title":"Urol. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1111\/bju.16364","article-title":"Surveillance of non-muscle-invasive bladder cancer with blue-light cystoscopy: A meta-analysis","volume":"134","author":"Ghoreifi","year":"2024","journal-title":"BJU Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0302-2838(03)00210-0","article-title":"Reduced specificity of 5-ALA induced fluorescence in photodynamic diagnosis of transitional cell carcinoma after previous intravesical therapy","volume":"44","author":"Grimbergen","year":"2003","journal-title":"Eur. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.eururo.2009.09.037","article-title":"Photodynamic diagnosis (5-aminolevulinic acid) of transitional cell carcinoma after bacillus Calmette-Gu\u00e9rin immunotherapy and mitomycin C intravesical therapy","volume":"57","author":"Draga","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/iju.70045","article-title":"Pathological Analysis of False-Positive Samples in Photodynamic Diagnosis of Bladder Cancer According to a History of Intravesical Bacillus Calmette-Gu\u00e9rin Therapy","volume":"32","author":"Sano","year":"2025","journal-title":"Int. J. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1111\/iju.70134","article-title":"Preoperative Pyuria as a Predictor of False-Positive Rates in the Photodynamic Diagnosis of Nonmuscle-Invasive Bladder Cancer Using Oral 5-Aminolevulinic Acid","volume":"32","author":"Yamamoto","year":"2025","journal-title":"Int. J. Urol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s10147-019-01447-5","article-title":"High diagnostic efficacy of 5-aminolevulinic acid-induced fluorescent urine cytology for urothelial carcinoma","volume":"24","author":"Yamamichi","year":"2019","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s13193-021-01340-6","article-title":"5-ALA-Induced Fluorescent Cytology in the Diagnosis of Bladder Cancer-a Preliminary Report","volume":"12","author":"Shadab","year":"2021","journal-title":"Indian. J. Surg. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Miyake, M., Nishimura, N., Nakai, Y., Fujii, T., Owari, T., Hori, S., Morizawa, Y., Gotoh, D., Anai, S., and Torimoto, K. (2021). Photodynamic Diagnosis-Assisted Transurethral Resection Using Oral 5-Aminolevulinic Acid Decreases the Risk of Repeated Recurrence in Non-Muscle-Invasive Bladder Cancer: A Cumulative Incidence Analysis by the Person-Time Method. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020185"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/s10147-024-02638-5","article-title":"Effect of extending the period from oral administration of 5-aminolevulinic acid hydrochloride to photodynamic diagnosis during transurethral resection for non-muscle invasive bladder cancer on diagnostic accuracy and safety: A single-arm multicenter phase III trial","volume":"30","author":"Taoka","year":"2025","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"711.e711","DOI":"10.1016\/j.clgc.2023.04.011","article-title":"The Impact of Blue Light Cystoscopy Use Among Nonmuscle Invasive Bladder Cancer Patients in an Equal Access Setting: Implications on Recurrence and Time to Recurrence","volume":"21","author":"Das","year":"2023","journal-title":"Clin. Genitourin. Cancer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"201","DOI":"10.21873\/cdp.10027","article-title":"Significance of 5-Aminolevulinic Acid-mediated Photodynamic Diagnosis Following Standard Transurethral Resection in Non-muscle Invasive Bladder Cancer","volume":"1","author":"Watanabe","year":"2021","journal-title":"Cancer Diagn. Progn."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/iju.14854","article-title":"Bladder cancer prospective cohort study on high-risk non-muscle invasive bladder cancer after photodynamic diagnosis-assisted transurethral resection of the bladder tumor (BRIGHT study)","volume":"29","author":"Kobayashi","year":"2022","journal-title":"Int. J. Urol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1111\/iju.15477","article-title":"Comprehensive analysis of perioperative hypotension in photodynamic diagnosis-assisted transurethral resection of bladder tumor with 5-aminolevulinic acid","volume":"31","author":"Nohara","year":"2024","journal-title":"Int. J. Urol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"EVIDoa2200092","DOI":"10.1056\/EVIDoa2200092","article-title":"A Randomized Trial of PHOTOdynamic Surgery in Non-Muscle-Invasive Bladder Cancer","volume":"1","author":"Heer","year":"2022","journal-title":"NEJM Evid."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.euros.2023.05.003","article-title":"Photodynamic Diagnosis-guided Transurethral Resection of Bladder Tumour in Participants with a First Suspected Diagnosis of Intermediate- or High-risk Non-muscle-invasive Bladder Cancer: Cost-effectiveness Analysis Alongside a Randomised Controlled Trial","volume":"53","author":"Yu","year":"2023","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"10.e7","DOI":"10.1016\/j.urolonc.2021.05.023","article-title":"Macro and microeconomics of blue light cystoscopy with CYSVIEW\u00ae in non-muscle invasive bladder cancer","volume":"40","author":"Williams","year":"2022","journal-title":"Urol. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1080\/13696998.2023.2267929","article-title":"A cost-consequences and budget impact analysis of blue light-guided cystoscopy with Hexvix in patients diagnosed with non-muscle-invasive bladder cancer in France","volume":"26","author":"Belsey","year":"2023","journal-title":"J. Med. Econ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"207.e209","DOI":"10.1016\/j.urolonc.2022.11.014","article-title":"Clinical and economic impact of blue light cystoscopy in the management of NMIBC at US ambulatory surgical centers: What is the site-of-service disparity?","volume":"41","author":"Shore","year":"2023","journal-title":"Urol. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Hagimoto, H., Makita, N., Mine, Y., Kokubun, H., Murata, S., Abe, Y., Kubota, M., Tsutsumi, N., Yamasaki, T., and Kawakita, M. (2021). Comparison between 5-aminolevulinic acid photodynamic diagnosis and narrow-band imaging for bladder cancer detection. BMC Urol., 21.","DOI":"10.1186\/s12894-021-00946-w"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Russo, G.I., Sholklapper, T.N., Cocci, A., Broggi, G., Caltabiano, R., Smith, A.B., Lotan, Y., Morgia, G., Kamat, A.M., and Witjes, J.A. (2021). Performance of Narrow Band Imaging (NBI) and Photodynamic Diagnosis (PDD) Fluorescence Imaging Compared to White Light Cystoscopy (WLC) in Detecting Non-Muscle Invasive Bladder Cancer: A Systematic Review and Lesion-Level Diagnostic Meta-Analysis. Cancers, 13.","DOI":"10.3390\/cancers13174378"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.pdpdt.2015.12.011","article-title":"The clinical trial on the safety and effectiveness of the photodynamic diagnosis of non-muscle-invasive bladder cancer using fluorescent light-guided cystoscopy after oral administration of 5-aminolevulinic acid (5-ALA)","volume":"13","author":"Inoue","year":"2016","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1111\/iju.14099","article-title":"Intraoperative hypotension caused by oral administration of 5-aminolevulinic acid for photodynamic diagnosis in patients with bladder cancer","volume":"26","author":"Nohara","year":"2019","journal-title":"Int. J. Urol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"103294","DOI":"10.1016\/j.pdpdt.2023.103294","article-title":"Risks and benefits of transurethral resection of the bladder tumor using photodynamic diagnosis with oral 5-aminolevulinic acid hydrochloride according to age and history of recurrence in patients with non-muscle invasive bladder cancer","volume":"41","author":"Kobayashi","year":"2023","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"104291","DOI":"10.1016\/j.pdpdt.2024.104291","article-title":"Identification of risk factors associated with oral 5-aminolevulinic acid induced adverse events in photodynamic diagnosis-transurethral resection of bladder tumor","volume":"49","author":"Okabe","year":"2024","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1093\/jjco\/hyaf047","article-title":"Comparing oncological outcomes and safety between photodynamic diagnosis-assisted and white-light transurethral resection in elderly patients with non-muscle invasive bladder cancer","volume":"55","author":"Matsushita","year":"2025","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"105365","DOI":"10.1016\/j.pdpdt.2026.105365","article-title":"Risk Factors and Management of Hypotension and Nausea during 5-Aminolevulinic Acid-Assisted Transurethral Resection of Bladder Tumors under Spinal Anesthesia","volume":"58","author":"Hirao","year":"2026","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Fukuhara, H., Nohara, T., Nishimoto, K., Hatakeyama, Y., Hyodo, Y., Okuhara, Y., Oyama, M., Mizokami, A., Inoue, K., and Matsuyama, H. (2021). Identification of risk factors associated with oral 5-aminolevulinic acid-induced hypotension in photodynamic diagnosis for non-muscle invasive bladder cancer: A multicenter retrospective study. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08976-1"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/iju.15341","article-title":"Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5-aminolevulinic acid","volume":"31","author":"Ishikawa","year":"2024","journal-title":"Int. J. Urol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1111\/iju.70226","article-title":"Association Between Preoperative 5-Aminolevulinic Acid Administration Timing and Perioperative Hypotension","volume":"32","author":"Hori","year":"2025","journal-title":"Int. J. Urol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e70328","DOI":"10.1111\/iju.70328","article-title":"Predictive Factors for Gastrointestinal and Hepatic Adverse Events During 5-Aminolevulinic Acid-Guided Photodynamic Diagnosis in Bladder Cancer: Exploratory Analysis of the Phase III SPP2C102 Trial","volume":"33","author":"Taoka","year":"2026","journal-title":"Int. J. Urol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1111\/iju.13856","article-title":"Transient liver toxicity as a result of the oral administration of 5-aminolevulinic acid for photodynamic diagnosis in patients with bladder cancer","volume":"26","author":"Miyake","year":"2019","journal-title":"Int. J. Urol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.eururo.2025.02.023","article-title":"European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: Summary of the 2025 Update","volume":"87","author":"Birtle","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.aju.2017.01.003","article-title":"Photodynamic diagnosis in upper urinary tract urothelial carcinoma: A systematic review","volume":"15","author":"Osman","year":"2017","journal-title":"Arab. J. Urol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"E596","DOI":"10.1111\/j.1464-410X.2012.11326.x","article-title":"Oral 5-aminolevulinic acid in simultaneous photodynamic diagnosis of upper and lower urinary tract transitional cell carcinoma\u2014A prospective audit","volume":"110","author":"Ahmad","year":"2012","journal-title":"BJU Int."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101617","DOI":"10.1016\/j.pdpdt.2019.101617","article-title":"5-aminolevulinic acid-mediated photodynamic diagnosis using fluorescence ureterorenoscopy for urinary upper tract urothelial carcinoma \u223cPreliminary prospective single centre trial\u223c","volume":"29","author":"Fukuhara","year":"2020","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1089\/end.2019.0725","article-title":"Photodynamic Diagnosis with Oral 5-Aminolevulinic Acid for Upper Urinary Tract Carcinoma: A Prospective Clinical Trial","volume":"34","author":"Yoshida","year":"2020","journal-title":"J. Endourol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Wada, K., Araki, M., Tanimoto, R., Sadahira, T., Watari, S., Maruyama, Y., Mitsui, Y., Nakajima, H., Acosta, H., and Katayama, S. (2021). Photodynamic diagnostic ureteroscopy using the VISERA ELITE video system for diagnosis of upper-urinary tract urothelial carcinoma: A prospective cohort pilot study. BMC Urol., 21.","DOI":"10.1186\/s12894-021-00819-2"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00345-024-05083-1","article-title":"Diagnostic performance of photodynamic diagnosis with oral 5-aminolevulinic acid for upper tract- and bladder urothelial carcinoma: A single-centre, retrospective analysis","volume":"42","author":"Sano","year":"2024","journal-title":"World J. Urol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1245\/s10434-024-16351-0","article-title":"Photodynamic Diagnosis-Guided Ureteroscopic Laser Ablation of Upper Urinary Tract Urothelial Carcinoma: Phase 2, Open-Label, Single-Arm Trial","volume":"32","author":"Yoshida","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.pdpdt.2012.06.004","article-title":"Oral 5-aminolevulinic acid induced Photodynamic Diagnostic Ureterorenoscopy--does the blood pressure require monitoring?","volume":"10","author":"Bondad","year":"2013","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/JU.0000000000001911","article-title":"Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I","volume":"206","author":"Campbell","year":"2021","journal-title":"J. Urol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.eururo.2025.02.020","article-title":"European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update","volume":"87","author":"Bex","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.juro.2011.02.2701","article-title":"Near infrared fluorescence imaging with robotic assisted laparoscopic partial nephrectomy: Initial clinical experience for renal cortical tumors","volume":"186","author":"Tobis","year":"2011","journal-title":"J. Urol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1089\/end.2012.0756","article-title":"Indocyanine green cannot predict malignancy in partial nephrectomy: Histopathologic correlation with fluorescence pattern in 100 patients","volume":"27","author":"Manny","year":"2013","journal-title":"J. Endourol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.eururo.2018.09.015","article-title":"\u201cRide the Green Light\u201d: Indocyanine Green-marked Off-clamp Robotic Partial Nephrectomy for Totally Endophytic Renal Masses","volume":"75","author":"Simone","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1046\/j.1464-410x.1999.00977.x","article-title":"Kidney-preserving tumour resection in renal cell carcinoma with photodynamic detection by 5-aminolaevulinic acid: Preclinical and preliminary clinical results","volume":"83","author":"Popken","year":"1999","journal-title":"BJU Int."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1007\/s10895-015-1626-x","article-title":"Expression of Genes Involved in Porphyrin Biosynthesis Pathway in the Human Renal Cell Carcinoma","volume":"25","author":"Silva","year":"2015","journal-title":"J. Fluoresc."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.urology.2007.12.086","article-title":"Photodynamic diagnosis of prostate cancer using 5-aminolevulinic acid--first clinical experiences","volume":"72","author":"Zaak","year":"2008","journal-title":"Urology"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.eururo.2009.02.027","article-title":"Photodynamic diagnosis using 5-aminolevulinic acid for the detection of positive surgical margins during radical prostatectomy in patients with carcinoma of the prostate: A multicentre, prospective, phase 2 trial of a diagnostic procedure","volume":"55","author":"Adam","year":"2009","journal-title":"Eur. Urol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1089\/end.2009.0374","article-title":"Intraoperative photodynamic evaluation of surgical margins during endoscopic extraperitoneal radical prostatectomy with the use of 5-aminolevulinic acid","volume":"23","author":"Ganzer","year":"2009","journal-title":"J. Endourol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1111\/j.1442-2042.2011.02789.x","article-title":"Photodynamic diagnosis of positive margin during radical prostatectomy: Preliminary experience with 5-aminolevulinic acid","volume":"18","author":"Fukuhara","year":"2011","journal-title":"Int. J. Urol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.urology.2013.06.051","article-title":"Application of 5-aminolevulinic acid-mediated photodynamic diagnosis to robot-assisted laparoscopic radical prostatectomy","volume":"82","author":"Inoue","year":"2013","journal-title":"Urology"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Fukuhara, H., Inoue, K., Kurabayashi, A., Furihata, M., and Shuin, T. (2015). Performance of 5-aminolevulinic-acid-based photodynamic diagnosis for radical prostatectomy. 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Oncol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/01.ju.0000100480.70769.0e","article-title":"Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy","volume":"171","author":"Schmidbauer","year":"2004","journal-title":"J. Urol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"104425","DOI":"10.1016\/j.pdpdt.2024.104425","article-title":"Comparison of fluorescence intensity of protoporphyrin IX as observed on the screen of different cystoscopic systems","volume":"51","author":"Fukuhara","year":"2025","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"21484","DOI":"10.1038\/s41598-023-48882-z","article-title":"Enhancing the image quality of blue light cystoscopy through green-hue correction and fogginess removal","volume":"13","author":"Chang","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/s43856-024-00705-6","article-title":"Low-cost and label-free blue light cystoscopy through digital staining of white light cystoscopy videos","volume":"4","author":"Chang","year":"2024","journal-title":"Commun. Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"11629","DOI":"10.1038\/s41598-021-91081-x","article-title":"Deep learning-based classification of blue light cystoscopy imaging during transurethral resection of bladder tumors","volume":"11","author":"Ali","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1093\/jnci\/djab179","article-title":"An Artificial Intelligence System for the Detection of Bladder Cancer via Cystoscopy: A Multicenter Diagnostic Study","volume":"114","author":"Wu","year":"2022","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"165013","DOI":"10.1088\/1361-6560\/ace499","article-title":"Tumor detection under cystoscopy with transformer-augmented deep learning algorithm","volume":"68","author":"Jia","year":"2023","journal-title":"Phys. Med. Biol."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Nishimura, N., Miyake, M., Onishi, S., Tomizawa, M., Shimizu, T., Onishi, K., Hori, S., Morizawa, Y., Gotoh, D., and Nakai, Y. (2024). The Circadian Rhythm of Intracellular Protoporphyrin IX Accumulation Through Heme Synthesis Pathway in Bladder Urothelial Cancer Cells Exposed to 5-Aminolevulinic Acid. 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