Thulium laser conservative treatment of upper tract urinary cancer: 10 years-experience of a referral center
To evaluate the efficacy and safety of retrograde intrarenal thulium laser treatment of upper tract urinary tumors (UTUC)
From 2005 to 2016 we enrolled 146 consecutive patients with new diagnosis of UTUC undergoing diagnostic ureterorenoscopy and thulium laser treatment at one referral institution. The instruments utilized were the Semirigid Ureteroscope 7Fr and Flexible Ureteroscope 7,5Fr. The Laser source was the Thullium and Holmium Yag (Revolix Duo) at 10 watts, with 270 micron fibers. Biopsies were made with nitinol basket 2,2 Fr and with 3 Fr flexible forceps. We applied EAU guidelines follow-up scheme: endoscopic control and cytology initially every 3 months, then every 6 months for 2 years and once a year; yearly Uro-CT.
Mean age at surgery was 70.7 years old (range 19-91, SD 8.49). Median follow-up was 36.7 (range 12-120) months. Imperative cases consisted of 21 (14.4%) solitary kidney patients. Bilateral UTUC was reported in 9 (6.2%) patients. Solitary tumours were reported in 91 patients (62.3 %), multiple in 55 patients (37.7%). Tumors were > 1 cm in dimension in 83 (56.9%) patients, smaller in 63 patients (43.1%). Tumors were above the uretero-pelvic junction (UPJ) in 75 (51.4%) patients (20 patients with synchronous lesions above and under the UPJ), below the UPJ in 71 patients (48.6%). Biopsies revealed the presence of low grade disease in 102 (69.9%) patients, high grade in 44 (30.1%) patients. Final stage was pTa in 120 (82.2%) patients. At first follow up, 52 patients (35.6%) were recurrence-free, 71 patients (48.6%) had recurrences, 23 patients (15.8%) underwent nephroureterectomy. During follow-up a total 61 patients (41.8%) were continuously recurrence-free, 55 patients (37.7%) had multiple recurrences treated conservatively and a total of 30 patients (20.5%) underwent nephroureterectomy. The Kidney Preserving Rate was 91,8%. No major complication was registered during or after the procedure. The 90.4% of patients were sent home the day after the procedure.
The conservative treatment of UTUC with thulium laser is safe and effective in terms of oncological outcomes. A complete staging of the neoplasia and a close follow-up are mandatory in order to be able to choose the optimal therapeutic strategy for each patient and to have good control of the disease