V03-08 en Bloc Enucleation of Upper Tract Urothelial Carcinoma to Improve Oncologic Control and Tissue Yield During Ureteroscopy

You have accessJournal of UrologyUrolithiasis/Endourology (V03)1 May 2024V03-08 EN BLOC ENUCLEATION OF UPPER TRACT UROTHELIAL CARCINOMA TO IMPROVE ONCOLOGIC CONTROL AND TISSUE YIELD DURING URETEROSCOPY Cyrus Chehroudi, Louisa Ho, and Sri Sivalingam Cyrus ChehroudiCyrus Chehroudi , Louisa HoLouisa Ho , and Sri SivalingamSri Sivalingam View All Author Informationhttps://doi.org/10.1097/01.JU.0001009524.48282.6c.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract urothelial carcinoma (UTUC) is a less common disease that carries high risk for metastatic spread and under-staging. The gold standard for management is radical nephroureterectomy (NU), but can be associated with increased perioperative risk and progression to chronic kidney disease. Endoscopic management is therefore an attractive option to preserve renal function and minimize patient morbidity, but has been limited by the capabilities of holmium laser. There are few studies on the technique and efficacy of endoscopic ablation using novel Thulium Fiber Laser (TFL), and specifically whether its shallower tissue penetration and improved water absorption will translate into improved hemostasis and cancer control. METHODS: We demonstrate a technique for tumor management via endoscopic enucleation using TFL in an 86-year-old lady with multiple medical co-morbidities who does not qualify for NU. RESULTS: Ureteroscopy was performed under general anesthesia in dorsal lithotomy position. Rigid cystoscopy and retrograde pyelogram are completed. A 12/14 F x 28 cm ureteral access sheath (UAS) is inserted over a stiff wire, with a second hybrid safety wire. A digital ureteroscope is used to inspect the collecting system for tumor. Once the lesion is identified, a 200 µm TFL is used to enucleate the tumor en bloc (2 J/10 Hz). Enucleated specimen is retrieved using a tipless nitinol basket and submitted for pathology. Tumor base is then ablated (2 J/10 Hz), maintaining closer contact with tissue to take advantage of the coagulative effect of TFL. The frequency can be lowered to target and coagulate a specific bleeder (2 J/5 Hz). Final retrograde pyelogram is performed to confirm no extravasation and the UAS is removed under direct vision. A ureteral stent is placed over the safety wire under fluoroscopic control. The patient is discharged home the same day without complication. Tumor specimen returned as high-grade urothelial carcinoma. CONCLUSIONS: TFL has several advantages over conventional holmium laser in the endoscopic management of UTUC including improved hemostasis and precise control of ablation depth, while maintaining clear visibility for the entirety of the procedure. These benefits allow Urologists to use more diverse techniques such as enucleation to address different tumor configurations and optimize tissue retrieval. Further studies are required to determine whether these advantages of TFL will translate into more accurate tissue diagnosis, cancer control, and freedom from extirpative surgery. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e193 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Cyrus Chehroudi More articles by this author Louisa Ho More articles by this author Sri Sivalingam More articles by this author Expand All Advertisement PDF downloadLoading ...