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Abstract

Objective:

To describe the step by step technique of flexible ureteroscopy (fURS) in the treatment of upper urinary tract carcinomas (UTUC) reporting the different modalities of visualization supplied by SPIES technology and to determine whether this enhancing system could improve the detection of malignancy.

Materials and Methods:

Twelve patients underwent 17 fURS procedures for UTUC using white light (WL) and the five modalities of SPIES technology (Clara, Chroma, Clara+Chroma, SPECTRA A, and SPECTRA B). Biopsies were carried out from all suspicious areas, reporting which modality they were seen with. All procedures were performed by a single urologist.

Results:

Optimal outcomes in the conservative management of UTUC are possible only with rigorous standardization of the procedure as follows: cystoscopy, ureteroscopy, urinary cytology in situ, navigation of the collecting system with WL and with SPIES technology (the different modalities are shown in the video), identification of the defect of upper urinary tract and the suspicious areas, biopsy and consequent laser treatment of the tumors and, last but not least, teaming up. A total of 35 pelvicalyceal biopsies were performed: 22 (63%) were visualized by both WL and SPIES technology and 91% of these were malignant, while 13 (37%) lesions were seen only under SPIES technology and 69% of these were malignant.

Conclusion:

We have described step by step fURS in the treatment of UTUC using SPIES technology. These findings on the use of SPIES technology are preliminary; in this pilot study, SPIES technology improves tumor detection rate by 26% compared with WL. Randomized studies with a larger population of patients are needed to confirm whether this technology will be useful to increase UTUC detection rate easing a safe endoscopic management of this rare oncological disease.