Thulium-Holmium:YAG Duo laser in conservative upper tract urothelial cancer treatment: 13 years-experience from a tertiary national referral center.J Endourol 2019JE
Introduction and Objectives To evaluate ablative safety and efficacy of Thulium-Holmium:YAG Duo laser in renal conservative retrograde intra-renal 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 endo-diagnostic procedure, 42 declined rigorous endosurveillance (ES) protocol and went elsewhere for alternative treatment, leaving 136 patients of whom 35 patients who dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This left 101 candidates 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 mo.), 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 (KPR) was 91%, while in imperative indications, it was 87.5%. Clavien Dindo grade I complications only (self-limiting hematuria) were reported in 10 %. Conclusions Over a thirteen year period, RC-RIRS UTUC treatment with the Thulium-Holmium:YAG Duo laser was safe and oncologically non-inferior to alternative combination laser energy technologies used for this indication .