V08-11 Tumor Flap Biopsy as a Novel Approach to Endoscopic Management of Upper Tract Tumors

You have accessJournal of UrologyBladder & Urothelial Upper Tract Oncology (V08)1 May 2024V08-11 TUMOR FLAP BIOPSY AS A NOVEL APPROACH TO ENDOSCOPIC MANAGEMENT OF UPPER TRACT TUMORS Britney Lau, Elizabeth Bearrick, Tal Cohen, Bridget Findlay, Yeonsoo Sara Lee, Aaron Potretzke, and Vidit Sharma Britney LauBritney Lau , Elizabeth BearrickElizabeth Bearrick , Tal CohenTal Cohen , Bridget FindlayBridget Findlay , Yeonsoo Sara LeeYeonsoo Sara Lee , Aaron PotretzkeAaron Potretzke , and Vidit SharmaVidit Sharma View All Author Informationhttps://doi.org/10.1097/01.JU.0001009440.59296.9f.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately 60% of upper tract urothelial carcinoma cases are invasive at diagnosis. The gold standard treatment is nephroureterectomy, however there is an increased risk of progression of chronic kidney disease. Additionally, the use of standard cold cup ureteroscopic biopsy for diagnosis is limited, as insufficient tissue is often collected and crush effect can impair the ability for pathologic analysis. We aim to demonstrate that a tumor flap biopsy approach allows for improved tumor sampling, which improves both diagnostic and therapeutic abilities. We present the case of a patient with a distal ureteral tumor biopsied with this technique. METHODS: Semi-rigid ureteroscopy was performed, and tumor was encountered in the distal ureter. Using the holmium laser, a flap was created underneath the tumor. A combination of gentle pressure from the tip of the ureteroscope and laser ablation was used to propagate the flap. Once the tumor flap had been adequately mobilized, the tumor was grasped and extracted using a nitinol basket. Retrograde pyelogram was performed, demonstrating no contrast extravasation, and ureteral stent was placed. RESULTS: Final pathology demonstrated high grade urothelial carcinoma, with muscle present and involved. Our dedicated genitourinary pathologist noted that the specimen was larger than typical samples provided from ureteroscopic biopsies, which augmented the ability to perform pathologic staging. CONCLUSIONS: A tumor flap biopsy approach provides higher tissue yield than standard ureteroscopic biopsy, which can augment pathologic staging and improve the efficacy of endoscopic management of upper tract tumors. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e560 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Britney Lau More articles by this author Elizabeth Bearrick More articles by this author Tal Cohen More articles by this author Bridget Findlay More articles by this author Yeonsoo Sara Lee More articles by this author Aaron Potretzke More articles by this author Vidit Sharma More articles by this author Expand All Advertisement PDF downloadLoading ...