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Minerva Urologica e Nefrologica 2020 Jan 30

DOI: 10.23736/S0393-2249.20.03689-9


lingua: Inglese

Thulium-laser Retrograde Intra Renal Ablation (T-RIRA) 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 Chiara SIGHINOLFI 12, Bernardo ROCCO 1, 12, Carlo BUIZZA 2, Evangelos LIATSIKOS 1, 14

1 ESUT, European Section for UroTechnology EAU, Arnhem, the Netherland; 2 Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy; 3 Urology Department, ICZ, Monza, Italy; 4 Urology Department, Ospedale Poma, Mantova, Italy; 5 Urology Department, Università “La Sapienza”, Latina, Italy; 6 Urology Department, INT, Milan, Italy; 7 Urology Department, Fundacio Puigvert, Barcelona, Spain; 8 Urology Department, University of Heidelberg, Heilbronn, Germany; 9 Urology Department, Athens Univerity, Athens, Greece; 10 Urology Department, Hamburg Hospital, Hamburg, Germany; 11 Urology Department, Cottolengo Hospital, Turin, Italy; 12 Urology Department, Baggiovara Hospital, Modena, Italy; 13 Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt; 14 Urology Department, 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 managementand follow-up (low-grade tumor).
RESULTS: RNU was performed in 31 patients, while the remaining 47 patients (undergone ™: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 lowgrade UTUC.

KEY WORDS: Upper urinary tract Transitional cell carcinoma; Thulium Laser; Endoscopic management; Conservative management

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