Exploring the role of thulium fiber laser in conservative treatment of UTUC: oncological and surgical outcomes

BACKGROUND: To evaluate the surgical outcomes and the safety profile of patients treated with thulium fiber laser (TFL) for the ablation of upper tract urothelial cancer (UTUC). METHODS: Between January 2022 and May 2024, 33 patients underwent URS for UTUC ablation using TFL in a single referral center. Data were collected prospectively and analyzed retrospectively. Baseline characteristics, peri- and post-operative surgical outcomes were reviewed. All procedures were performed by the same dedicated team specializing in endourological treatments of UTUC, with a minimum follow-up of six months. Intraoperative, 30-day and 90-day postoperative complications were collected and classified according to Clavien-Dindo Classification. Residual disease was assessed in patients undergoing second-look ureteroscopy. RESULTS: Median age was 74 (70-83) years and 70% had an ASA score ≥3. Papillary exophytic tumors were most common (24/33), with urothelial carcinoma confirmed in 28 cases, including 20 high-grade UTUCs. Intraoperative complications occurred in four patients, with only one Grade 2 complication. Overall, 76% experienced no postoperative complications, while the 30- and 90-day complication rates were 24% and 21%, respectively, with only one major complication (3%). Residual disease was found in four of 19 patients who underwent second-look URS. Limitations include the lack of a comparison arm and small sample size. CONCLUSIONS: This study is the largest series on TFL for UTUC ablation and confirms its safety with low major complication rates and promising oncological outcomes, supporting its inclusion in the laser armamentarium for UTUC management.