Thulium Laser Treatment of Upper Urinary Tract Carcinoma: A Multi-Institutional Analysis of Surgical and Oncological Outcomes

Abstract

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.

Editorial Comment from Dr Castelli to Thulium laser ablation facilitates retrograde intra‐renal surgery for upper urinary tract urothelial carcinoma

“…The conclusions of the authors are also supported by a recent series of 42 patients treated endoscopically with Tm:YAG laser for both low‐risk and high‐risk UTUC; optimal vaporization and hemostasis was obtained in the absence of major complications, and just 12% of the patients required a second‐look procedure, 19% of the patients experienced clinical recurrence, 9.5% of the patients required radical nephroureterectomy and no progression or upstaging of disease occurred after a median follow‐up period of 26 months.…”

Salvage topical therapy for upper tract urothelial carcinoma

“…No patients discontinued therapy due to AEs. In the report by Musi and colleagues, Grade 1, 2, and 3 AEs were reported in 38%, 47.6%, and 2.4%, respectively [9]. An important consideration is that we cannot definitively identify topical therapy directly caused these local adverse events.…”

“…Endoscopic management of UTUC via a percutaneous or ureteroscopic approach is feasible and safe in selected patients[4]. Unfortunately, reported recurrence rates following this treatment modality range from 30% to 70% depending upon tumor stage and grade[6,8], although a recent study by Musi and colleagues using the Thulium laser has shown lower recurrence rates of 20–25% after a median follow up of 26.3 months [9]. In bladder cancer, intravesical instillation therapy has been established as a viable adjuvant therapy to reduce recurrence and progression of superficial disease[10].…”

Consultation on UTUC, Stockholm 2018: aspects of treatment

“…In a meta-analysis examining the impact of URS before RNU on oncological outcomes [15], patients with initial URS had a significantly higher risk of bladder recurrence; however, that had no impact on CSS, OS, recurrence-free survival (RFS), or metastasis-free survival (MFS). Several options are available for laser ablation, such as holmium, thulium, and neodymium, but there is little evidence regarding the pros and cons of the different modalities [16].…”