V03-06 Ureteroscopic Management of Upper Urinary Tract Urothelial Carcinoma With Thulium Fiber Laser: 10 Steps for a Good Biopsy and Ablation Strategy

You have accessJournal of UrologyUrolithiasis/Endourology (V03)1 May 2024V03-06 URETEROSCOPIC MANAGEMENT OF UPPER URINARY TRACT UROTHELIAL CARCINOMA WITH THULIUM FIBER LASER: 10 STEPS FOR A GOOD BIOPSY AND ABLATION STRATEGY Golena Fernandez Moncaleano, Nik B. Patel, Jennifer M. Thelus, and Khurshid R. Ghani Golena Fernandez MoncaleanoGolena Fernandez Moncaleano , Nik B. PatelNik B. Patel , Jennifer M. ThelusJennifer M. Thelus , and Khurshid R. GhaniKhurshid R. Ghani View All Author Informationhttps://doi.org/10.1097/01.JU.0001009524.48282.6c.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For upper tract urothelial carcinoma (UTUC), American Urological Association (AUA) guidelines recommend diagnostic ureteroscopy and biopsy if imaging and cytology are not sufficient. Ablation is recommended as the initial management option for patients with low-risk favorable and be offered for low-risk unfavorable UTUC. One of the problems urologists face is obtaining reliable diagnostic biopsy. Also, now the Thulium Fiber Laser (TFL) is available with different properties which may have advantages for soft tissue ablation. In this video, we provide a step-by-step guide for biopsy, laser ablation strategies, fiber selection and settings. METHODS: Our hospital is a regional referral center for UTUC. Ureteroscopy is performed using either a flexible fiberoptic or digital ureteroscope depending on tumor volume and pre-stenting status. Ureteral access sheath (UAS) 12/14Fr is used when needed. Biopsies are performed with a 3Fr flexible forceps (Piranha, Boston Scientific) with an adjustable endoscopic valve (Uroseal, Steris). TFL (Soltive, Olympus) is used to ablate the tumor using either a 150 μm or 200 μm fiber. RESULTS: Important steps include: 1) No retrograde pyelography before cytology taken, 2) Use of a Pirahna forceps and Uroseal, 3) Biopsy technique with either a slow "push", or a "pull" of tissue, 4) Sample handling of forceps tissue: transfer direct into container and not using Telfa or needle, 5) Clearing the field for bleeding: "lock and flush", 6) Performing post biopsy cytology, 7) No UAS for small volume tumor and use of 150 μm fiber and gravity irrigation, 8) Cutting the tip of 150 μm fiber for easy insertion into working channel, 9) Use of UAS for large volume tumor at second stage with high flow irrigation and 200 μm fiber, 10) Laser setting of 1Jx10Hz short pulse. CONCLUSIONS: Ureteroscopic treatment of UTUC can be a straightforward and step-wise procedure. The TFL provides a new frontier in management. We hope this teaching video serves as a didactic tool that can help surgeons improve patient care. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e192 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Golena Fernandez Moncaleano More articles by this author Nik B. Patel More articles by this author Jennifer M. Thelus More articles by this author Khurshid R. Ghani More articles by this author Expand All Advertisement PDF downloadLoading ...