V407: Management of upper urinary tract urothelial tumor with ureteroscopic 1470nm Super pulsed diode laser
VideoIntroduction and Objectives
While nephroureterectomy with resection of bladder cuff remains the gold standard for management of urothelial tumors of the upper urinary tract, minimally invasive endoscopic strategies are gaining acceptance for management of low grade low stage upper tract urothelial tumors, particularly in elderly patients or those with significant comorbidity, and patients with impaired renal function. Currently, holmium:YAG and Neodymium:YAG lasers are in use for ablation of these tumors, but the procedure can be tedius. We report the first use of diode laser technology (1470nm) for the ablation of renal pelvic urothelial tumor.
The patient is a 65 year old man with a 5mm right renal pelvic tumor previously biopsied and shown to be papillary urothelial tumor of low malignant potential. The contralateral collecting system had atypia on cytology but no lesion on retrograde pyelogram or ureteroscopy. It was decided to proceed with laser ablation of the right renal pelvic tumor. The laser fiber used was a 1470nm diode laser that is 400um in diameter. The depth of penetration is 500um and both side fire and end fire fibers are available. An end fire fiber was used in this case.
The patient was positioned in lithotomy and after induction of anesthesia, access to the affected ureter was obtained in the usual manner, and a flexible ureteroscope passed up to the renal pelvis. After ureteroscopic survey of the collecting system, the tumor was identified and then completely ablated using the diode laser. The 5mm tumor was successfully ablated in 3.4 minutes with excellent hemostasis. A double J ureteral stent was placed. The patient tolerated the procedure well and was discharged home the same day.
Diode laser ablation of upper urinary tract tumors is efficient and hemostatic.