Giorgio Bozzini1,2, Christian Gastaldi3, Umberto Besana3, Alberto Calori3, Stefano Casellato4, Paolo Parma5, Antonio Pastore6, Alberto Macchi7, Alberto Breda8,9, Ali Gozen8,10, Andreas Skolarikos8,11, Thomas Herrmann8,12, Cesare Scoffone8,13, Ahmed Eissa14,15, Maria C Sighinolfi14, Bernardo Rocco8,14, Carlo Buizza3, Evangelos Liatsikos8,16. 1. ESUT (European section for UroTechnology), Arnehm, the Netherlands - gioboz@yahoo.it. 2. Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy - gioboz@yahoo.it. 3. Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy. 4. Department of Urology, Istituti Clinici Zucchi, Monza, Monza-Brianza, Italy. 5. Department of Urology, Poma Hospital, Mantua, Italy. 6. Department of Urology, Sapienza University, Latina, Italy. 7. Department of Urology, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy. 8. ESUT (European section for UroTechnology), Arnehm, the Netherlands. 9. Department of Urology, Puigvert Foundation, Barcelona, Spain. 10. Department of Urology, University of Heidelberg, Heilbronn, Germany. 11. Department of Urology, Athens Univerity, Athens, Greece. 12. Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland. 13. Department of Urology, Cottolengo Hospital, Turin, Italy. 14. Department of Urology, Baggiovara Hospital, Modena, Italy. 15. Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt. 16. Department of Urology, University of Patras, Patras, Greece.
Abstract
BACKGROUND: Radical nephroureterectomy (RNU) is the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC); however, patients presenting with small low-grade UTUC have been treated by flexible ureteroscopic laser ablation with good outcomes. Different types of laser have been discussed in the literature including Holmium and Neodymium lasers. We aimed to assess the safety and efficacy of Thulium laser (Tm:YAG) in the ureteroscopic ablation of UTUC. METHODS: A retrospective observational multicentre study of patients diagnosed with papillary UTUC between January 2015 and December 2016 was carried out. All patients underwent ureteroscopic biopsy of the UTUC followed by Tm:YAG ablation. Based on the histopathological grade of the tumor, patients were counseled to undergo either RNU (high- grade tumors) or conservative management and follow-up (low-grade tumor). RESULTS: RNU was performed in 31 patients, while the remaining 47 patients (undergone Tm:YAG ablation only) were followed up for a mean of 11.7 months with only 19.2% of patients showing upper tract recurrence and no patients showed postoperative ureteral strictures. Limitations include the short follow-up and retrospective nature of the study. CONCLUSIONS: On the short term, thulium Laser ablation of UTUC is safe and feasible especially in low-grade UTUC.
BACKGROUND: Radical nephroureterectomy (RNU) is the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC); however, patients presenting with small low-grade UTUC have been treated by flexible ureteroscopic laser ablation with good outcomes. Different types of laser have been discussed in the literature including Holmium and Neodymium lasers. We aimed to assess the safety and efficacy of Thulium laser (Tm:YAG) in the ureteroscopic ablation of UTUC. METHODS: A retrospective observational multicentre study of patients diagnosed with papillary UTUC between January 2015 and December 2016 was carried out. All patients underwent ureteroscopic biopsy of the UTUC followed by Tm:YAG ablation. Based on the histopathological grade of the tumor, patients were counseled to undergo either RNU (high- grade tumors) or conservative management and follow-up (low-grade tumor). RESULTS: RNU was performed in 31 patients, while the remaining 47 patients (undergone Tm:YAG ablation only) were followed up for a mean of 11.7 months with only 19.2% of patients showing upper tract recurrence and no patients showed postoperative ureteral strictures. Limitations include the short follow-up and retrospective nature of the study. CONCLUSIONS: On the short term, thulium Laser ablation of UTUC is safe and feasible especially in low-grade UTUC.
Authors: Jeremy Ng Chieng Hin; Dinul Hettiarachchilage; Paul Gravestock; Bhavan Rai; Bhaskar K Somani; Rajan Veeratterapillay Journal: Curr Urol Rep Date: 2021-10-07 Impact factor: 3.092