Presented by: Roman Andreev FACS
The S.I. Spasokukotsky City Clinical Hospital, Moscow, Russia

Introduction

Upper urinary tract urothelial carcinoma (UTUC) is a rare and dangerous disease that requires serious treatment. Radical nephroureterectomy has long been the gold standard treatment for UTUC, but it should only be used for large tumors because it can lead to serious complications. In this regard, small tumors of low malignancy are the most promising to operate with flexible ureteroscopic laser ablation, which allows to save the organ and avoid the development of complications. Various types of lasers for the treatment of UTUC are discussed in the literature, but the efficacy and safety of the Thulium (Tm:YAG) laser for ureteroscopic ablation of UTUC has not yet been studied.

The aim of the study: to evaluate the safety and efficiency of the Thulium laser in ureterorenoscopic ablation of UTUC to improve the treatment outcomes of patients with this disease.

Materials

To achieve this goal, a retrospective single center study of patients diagnosed with UTUC was performed between January 2018 and December 2022. All patients underwent ureterorenoscopy to visualize the tumor process, as well as a biopsy of the UTUC. Depending on the histopathological grade of the tumor, patients were recommended to undergo either radical nephrectomy (in case of high grade of malignancy) or retrograde intrarenal ablation of the tumor and follow-up (in case of low grade of malignancy).

The study was conducted to evaluate the results of retrograde intrarenal ablation of urothelial carcinoma using the Thulium laser. Forty patients participated in the study, 23 of whom underwent radical nephrectomy surgery, while the remaining 17 patients who underwent laser Tm:YAG ablation alone were followed up for 15 months.

Results

,

The study demonstrated high safety and efficacy of retrograde intrarenal ablation of urothelial carcinoma using the Thulium laser. Among the 17 patients who underwent laser ablation of UTUC, reoperation was required only in one case (5.9% of cases), which was due to the original size of the tumor. It is worth noting that hemostatic drugs and hemotransfusions were not used in any of the cases. The use of this method allows preserving the organ and minimizing the development of complications associated with renal failure.

Conclusion

Evaluation of the results of retrograde intrarenal ablation of urothelial carcinoma using Thulium laser showed its high efficiency and safety. The use of this technique allows not only preserving the organ, but also avoiding complications in the form of renal failure. However, an additional study with a larger number of patients and a prospective study design is required to assess these results more accurately.

Funding

no funding

Lead Authors

Konstantin Kolontarev, MD
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Dmitriy Pushkar, MD
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Co-Authors

Elena Lazareva, resident
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov