ESUT (European section for UroTechnology), Arnehm, the Netherlands -
Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy -
Minerva Urol Nephrol. 2021 Feb;73(1):114-121. doi: 10.23736/S2724-6051.20.03689-9. Epub 2020 Jan 30.
Radical nephroureterectomy (RNU) is the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC); however, patients presenting with small low-grade UTUC have been treated by flexible ureteroscopic laser ablation with good outcomes. Different types of laser have been discussed in the literature including Holmium and Neodymium lasers. We aimed to assess the safety and efficacy of Thulium laser (Tm:YAG) in the ureteroscopic ablation of UTUC.
A retrospective observational multicentre study of patients diagnosed with papillary UTUC between January 2015 and December 2016 was carried out. All patients underwent ureteroscopic biopsy of the UTUC followed by Tm:YAG ablation. Based on the histopathological grade of the tumor, patients were counseled to undergo either RNU (high- grade tumors) or conservative management and follow-up (low-grade tumor).
RNU was performed in 31 patients, while the remaining 47 patients (undergone Tm:YAG ablation only) were followed up for a mean of 11.7 months with only 19.2% of patients showing upper tract recurrence and no patients showed postoperative ureteral strictures. Limitations include the short follow-up and retrospective nature of the study.
On the short term, thulium Laser ablation of UTUC is safe and feasible especially in low-grade UTUC.
根治性肾输尿管切除术（RNU）是上尿路上皮癌（UTUC）的金标准治疗方法；然而，对于小的低级别 UTUC 患者，已经采用柔性输尿管镜激光消融术进行治疗，取得了良好的效果。文献中讨论了不同类型的激光，包括钬和钕激光。我们旨在评估钬：钇铝石榴石（Tm：YAG）激光在输尿管镜消融 UTUC 中的安全性和有效性。
对 2015 年 1 月至 2016 年 12 月期间诊断为乳头状 UTUC 的患者进行回顾性观察性多中心研究。所有患者均接受输尿管镜活检 UTUC 后行 Tm：YAG 消融术。根据肿瘤的组织病理学分级，对患者进行咨询，建议行 RNU（高级别肿瘤）或保守治疗和随访（低级别肿瘤）。
31 例患者行 RNU，其余 47 例（仅行 Tm：YAG 消融术）患者平均随访 11.7 个月，仅 19.2%的患者出现上尿路复发，无患者出现术后输尿管狭窄。局限性包括随访时间短和研究的回顾性。
短期内，钬激光消融 UTUC 是安全可行的，特别是对于低级别 UTUC。
