Abstract
Clinical History:
A 44-year-old female patient was evaluated because of right-sided flank pain. She had a history of multiple ureteral stents and six previous ureteroscopies/laser lithotripsy. Family history was negative. She quit smoking 7 years ago but was still drinking alcoholic beverages (2 drinks/week).
Physical Examination:
Besides morbid obesity (body mass index 50.5 kg/m2), it was unrevealing.
Diagnosis:
CT scan showed right hydronephrotic kidney caused by an obstructive stone in the right upper ureter (1.5 cm) and a nonobstructive stone in the right lower pole (1.2 cm).
Intervention:
Ureteroscopy incidentally showed a distal ureteral tumor with papillary projections. Specimens were collected for pathology analysis. For tumor ablation, we used the thulium fiber laser (TFL) combined with a 200 μm fiber, and settings to 1.0 J, 10 Hz, and 10 W of power. We continued with the same laser fiber to treat the ureteral stone, settings adjusted to 0.2 J, 40 Hz, and 8 W. Next, a flexible ureteroscope was used to treat kidney stones. The ablation prevented the use of an access sheath. After stone repositioning, we continued using the same 200 μm fiber, but with different settings: 0.3 J, 120 Hz, and 36 W. After stones treatment, a complete survey showed no additional tumors. Finally, a ureteral stent was placed. After stones treatment, a complete survey showed no additional tumors. Finally, a ureteral stent was placed.
Follow-up/Outcomes:
The patient was discharged on the same day. The pathology report revealed a benign urothelium, submucosal inflammation, and reactive changes. TFL was shown to be a versatile method to simultaneously treat three different endourologic conditions.
The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.
Dr. Wilson Molina is a consultant for Karl Storz®, Boston Scientific®, Olympus®, Johnson & Johnson®, and Fortech®.
No competing financial interests exist.
Runtime of video: 4 mins 59 secs
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