Thulium laser treatment of upper urinary tract carcinoma: A multi-institutional analysis of surgical and oncological outcomes

Gennaro Musi, Francesco A. Mistretta, Carlo Marenghi, Andrea Russo, Michele Catellani, Sebastiano Nazzani, Andrea Conti, Stefano Luzzago, Matteo Ferro, Deliu V. Matei, Luca Carmignani, Ottavio De Cobelli

Research output: Contribution to journalArticle

Abstract

Introduction: To evaluate the efficacy and safety of ureteroscopic thulium laser (TL) treatment of upper urinary tract carcinoma (UTUC). Materials and Methods: Forty-two consecutive patients underwent conservative TL treatment for UTUC at two referral institutions. All patients underwent preliminary biopsy and then laser vaporization. A 272 μm and 365 μm laser fibers were used with a flexible and semirigid scope, respectively. Ablation was carried out with a 10 to 20 W power. Results: Mean age at surgery was 68 years (SD 10.7). Mean tumor size was 14.3 mm (range 2-30 mm). Preliminary biopsy revealed the presence of low-grade disease in 29 (69.1%) patients, high-grade disease in 4 (9.5%) and 1 carcinoma in situ 1 (2.4%), whereas it was not conclusive in 8 (19%) cases. Final stage was pTa and pTis in 41 (97.6%) and 1 (2.4%) patients, respectively. Thirty eight percent (16) experienced Clavien-Dindo grade I complication, 47.6% (20) grade II, and 2.4% (1) grade III. Five (12%) patients underwent a second-look procedure due to residual disease. Eight (19%) patients experienced clinical recurrence. The median estimated recurrence-free survival was 44 months (SE 3.68). Four patients (9.5%) underwent a nephroureterectomy. Final pathological stage was pTis, pT3 high grade, pTa low grade, and pT0. Median follow-up was 26.3 months (range 2-54 months), and no progression or upstaging of disease occurred. Conclusions: TL management of UTUC is a safe and efficacious conservative treatment. Our experience shows optimal vaporization and hemostatic control in the absence of major complications.

Original languageEnglish
Pages (from-to)257-263
Number of pages7
JournalJournal of Endourology
Volume32
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

Keywords

  • carcinoma
  • conservative treatment
  • endoscopy
  • laser therapy
  • thulium
  • transitional cell

ASJC Scopus subject areas

  • Urology

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