Thulium–Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center

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.