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Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center.
J Endourol. 2019 11; 33(11):902-908.JE

Abstract

Introduction and

Objectives:

To evaluate ablative safety and efficacy of thulium-holmium:YAG (TL-HL:YAG) duo laser in renal conserving retrograde intrarenal surgery (RC-RIRS) in upper tract urothelial carcinoma (UTUC). Materials and

Methods:

A retrospective study was performed on 178 consecutive patients referred for consideration of RC-RIRS UTUC-eLA (endoscopic laser ablation) in a tertiary center (January 2005 to December 2018). Key data were recorded using a standardized study proforma.

Results:

After endodiagnostic procedure, 42 declined rigorous endosurveillance protocol and went elsewhere for alternative treatment, leaving 136 patients, of whom 35 patients dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This was left with 101 candidates who continued UTUC conservative management (intention-to-treat [ITT] population). Mean follow-up (FU) for these 101 patients was 28.7 months. At last FU (range 3-144 months), 70 patients (69.3%) were recurrence free, 22 (21.8%) had endoscopically treated recurrences, and a further 9 (8.9%) had undergone RNU. In the ITT population, kidney-preserving rate was 91%, whereas in imperative indications, it was 87.5%. Clavien-Dindo grade I complications only (self-limiting hematuria) were reported in 10%.

Conclusions:

Over a 13-year period, RC-RIRS UTUC treatment with the TL-HL:YAG duo laser was safe and oncologically noninferior to alternative combination laser energy technologies used for this indication.

Authors+Show Affiliations

Department of Urology, "Cristo Re" Hospital, Rome, Italy.Department of Urology, "Cristo Re" Hospital, Rome, Italy.Department of Urology, "Cristo Re" Hospital, Rome, Italy.Kech School of Medicine USC, Los Angeles, California.Department of Urology, Spire Roding, London, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31422699

Citation

Defidio, Lorenzo, et al. "Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience From a Tertiary National Referral Center." Journal of Endourology, vol. 33, no. 11, 2019, pp. 902-908.
Defidio L, Antonucci M, De Dominicis M, et al. Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center. J Endourol. 2019;33(11):902-908.
Defidio, L., Antonucci, M., De Dominicis, M., Fuchs, G., & Patel, A. (2019). Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center. Journal of Endourology, 33(11), 902-908. https://doi.org/10.1089/end.2019.0308
Defidio L, et al. Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience From a Tertiary National Referral Center. J Endourol. 2019;33(11):902-908. PubMed PMID: 31422699.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center. AU - Defidio,Lorenzo, AU - Antonucci,Michele, AU - De Dominicis,Mauro, AU - Fuchs,Gerhard, AU - Patel,Anup, Y1 - 2019/09/25/ PY - 2019/8/20/pubmed PY - 2019/8/20/medline PY - 2019/8/20/entrez KW - RIRS KW - UTUC KW - laser KW - thulium KW - upper tract urothelial SP - 902 EP - 908 JF - Journal of endourology JO - J. Endourol. VL - 33 IS - 11 N2 - Introduction and Objectives: To evaluate ablative safety and efficacy of thulium-holmium:YAG (TL-HL:YAG) duo laser in renal conserving retrograde intrarenal surgery (RC-RIRS) in upper tract urothelial carcinoma (UTUC). Materials and Methods: A retrospective study was performed on 178 consecutive patients referred for consideration of RC-RIRS UTUC-eLA (endoscopic laser ablation) in a tertiary center (January 2005 to December 2018). Key data were recorded using a standardized study proforma. Results: After endodiagnostic procedure, 42 declined rigorous endosurveillance protocol and went elsewhere for alternative treatment, leaving 136 patients, of whom 35 patients dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This was left with 101 candidates who continued UTUC conservative management (intention-to-treat [ITT] population). Mean follow-up (FU) for these 101 patients was 28.7 months. At last FU (range 3-144 months), 70 patients (69.3%) were recurrence free, 22 (21.8%) had endoscopically treated recurrences, and a further 9 (8.9%) had undergone RNU. In the ITT population, kidney-preserving rate was 91%, whereas in imperative indications, it was 87.5%. Clavien-Dindo grade I complications only (self-limiting hematuria) were reported in 10%. Conclusions: Over a 13-year period, RC-RIRS UTUC treatment with the TL-HL:YAG duo laser was safe and oncologically noninferior to alternative combination laser energy technologies used for this indication. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/31422699/Thulium-Holmium:YAG_Duo_laser_in_conservative_upper_tract_urothelial_cancer_treatment:_13_years-experience_from_a_tertiary_national_referral_center L2 - https://www.liebertpub.com/doi/full/10.1089/end.2019.0308?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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