ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2021 February;73(1):114-21

DOI: 10.23736/S2724-6051.20.03689-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Thulium-laser retrograde intra renal ablation of upper urinary tract transitional cell carcinoma: an ESUT Study

Giorgio BOZZINI ^{1, 2} ✉, Christian GASTALDI ², Umberto BESANA ², Alberto CALORI ², Stefano CASELLATO ³, Paolo PARMA ⁴, Antonio PASTORE ⁵, Alberto MACCHI ⁶, Alberto BREDA ^{1, 7}, Ali GOZEN ^{1, 8}, Andreas SKOLARIKOS ^{1, 9}, Thomas HERRMANN ^{1, 10}, Cesare SCOFFONE ^{1, 11}, Ahmed EISSA ^{12, 13}, Maria C. SIGHINOLFI ¹², Bernardo ROCCO ^{1, 12}, Carlo BUIZZA ², Evangelos LIATSIKOS ^{1, 14}

¹ ESUT (European section for UroTechnology), Arnehm, the Netherlands; ² Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy; ³ Department of Urology, Istituti Clinici Zucchi, Monza, Monza-Brianza, Italy; ⁴ Department of Urology, Poma Hospital, Mantua, Italy; ⁵ Department of Urology, Sapienza University, Latina, Italy; ⁶ Department of Urology, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy; ⁷ Department of Urology, Puigvert Foundation, Barcelona, Spain; ⁸ Department of Urology, University of Heidelberg, Heilbronn, Germany; ⁹ Department of Urology, Athens Univerity, Athens, Greece; ¹⁰ Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland; ¹¹ Department of Urology, Cottolengo Hospital, Turin, Italy; ¹² Department of Urology, Baggiovara Hospital, Modena, Italy; ¹³ Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt; ¹⁴ Department of Urology, University of Patras, Patras, Greece

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.

KEY WORDS: Urinary tract; Carcinoma, transitional cell; Conservative treatment