Diode Laser for the Management of Upper Tract Urothelial Cancer (UTUC) – Case Series.

Main Article Content

Joachim Jimie
Abigail Kwok
Fadi Housami
Mahmoud Elfar
Baher Hussein

Abstract

Background and Objective: Upper tract urothelial carcinoma (UTUC) is uncommon; however, at the time of diagnosis, they are usually more invasive than bladder urothelial carcinomas. Although nephroureterectomy (NU) has been the gold-standard treatment, guidelines have been set for kidney-sparing treatment in selected groups of patients. While these guidelines are aimed towards patients fit for salvage radical treatment, little has been published on managing the symptomatic patient not fit for NU. Various modalities of endoscopic ablation in managing UTUC have been described in the literature, but there is currently no reported use of the diode laser. Therefore, we aim to assess its efficacy and safety profile in the ablation of UTUC in patients unfit for major abdominal surgery in radical nephroureterectomy regardless of the tumour grade and size.


Patients and method: A single centre retrospective review of patients who underwent Diode Laser treatment for UTUC over 4 years was done. Follow up through 6 monthly ureteroscopy alternating with computed tomography (CT) urogram was done to assess the need for further treatment.


Results: 30 patients were identified, with mean age 76 years (64-88) and variable tumour locations, including lower and mid ureter and renal pelvis, upper and lower calyces. 76.7% were ASA 3 and 20% ASA 4. The mean tumour size was 3.8 cm (2-7 cm). The mean number of sessions was 2.1 (1-6). 63.3% of the tumours were grade 2, while 30% were grade 3. A case of metastatic renal-cell carcinoma was diagnosed as a 4 cm filling defect in the kidney where the diode laser was used for resection biopsy and ablation. 16.7% experienced Clavien-Dindo grades 1-2 complications. A total of 6.7% of patients were converted to an inpatient stay. None of the patients needed blood transfusion nor did any develop a ureteric stricture on subsequent ureteroscopies. 48.3% of patients experienced clinical recurrences of which 57.1% were at a different site. Two of the patients developed metastatic disease. One patient died 3 years after initial treatment with disease progression.


Conclusion: The management of UTUC with diode laser is a safe and efficacious conservative treatment for disease and symptom control in patients unfit for radical treatment.

Downloads

Download data is not yet available.

Article Details

How to Cite
Jimie, J., Kwok, A., Housami, F., Elfar, M., & Hussein, B. (2022). Diode Laser for the Management of Upper Tract Urothelial Cancer (UTUC) – Case Series. Journal of Endoluminal Endourology, 5(3), e14-e21. https://doi.org/10.22374/jeleu.v5i3.147
Section
Original Article
Author Biographies

Joachim Jimie, Aintree University Hospital, Liverpool, UK

Aintree University Hospital, Lower Lane, Liverpool, UK

Abigail Kwok, Aintree University Hospital, Lower Lane, Liverpool, UK

Aintree University Hospital, Lower Lane, Liverpool, UK

Fadi Housami, Aintree University Hospital, Lower Lane, Liverpool, UK

Aintree University Hospital, Lower Lane, Liverpool, UK

Mahmoud Elfar, Aintree University Hospital, Lower Lane, Liverpool, UK

Aintree University Hospital, Lower Lane, Liverpool, UK

Baher Hussein, Aintree University Hospital, Lower Lane, Liverpool, UK

Aintree University Hospital, Lower Lane, Liverpool, UK

References

1. Siegel RL, Miller K, Fuchs HE, Jemal A. Cancer Statistics 2021. CA Cancer J Clin 2021;71:7.
2. Mandalapu RS, Remzi M, de Reijke TM, Margulis V, Palou J, Kapoor A, et al. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma. World J Urol 2017; 35:355–65.
3. EAU Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma. European Association of Urology 2022. Available at: https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/chapter/disease-management
4. Murray K, Winer A, Bagrodia A, et al. Endoscopic management for upper tract urothelial cancer (UTUC) compared to immediate nephroureterectomy: survival outcomes in seer database and cancer center cohort. J Urol 2015;193(4).
5. Vemana G, Kim EH, Bhayani SB, et al. Survival comparison between endoscopic and surgical management for patients with upper tract urothelial cancer: a matched propensity score analysis using surveillance, epidemiology and end results-Medicare data. Urology 2016;95:115–20
6. Bozzini G, Gastaldi C, Besana U, et al. Thulium-laser retrograde intra renal ablation (T-RIRA) of upper urinary tract transitional cell carcinoma: an ESUT study. Minerva Urol Nefrol 2020.
7. Musi G, Mistretta FA, Marenghi C, Russo A, Catellani M, Nazzani S, et al. Thulium Laser Treatment of Upper Urinary Tract Carcinoma: A Multi-Institutional Analysis of Surgical and Oncological Outcomes. J Endourol 2018;32:257–63.
8. Yoshida T, Taguchi M, Inoue T, Kinoshita H, Matsuda T. Thulium laser ablation facilitates retrograde intra-renal surgery for upper urinary tract urothelial carcinoma. Int J Urol 2018;25:379–80
9. Vanacore D, Sanguedolce F, Montano B, et al. Evolving techniques of endoscopic UTUC management: optimising outcomes with the appropriate use of latest technologies. J Urol 2020.
10. Scotland KB, Hubbard L, Cason D, et al. Long-term outcomes of ureteroscopic management of upper tract urothelial carcinoma. Urol Oncol 2020;38(11):850 e17- e26.
11. Scotland KB, Kleinmann N, Cason D, et al. Ureteroscopic management of large >/=2 cm upper tract urothelial carcinoma: a comprehensive 23-year experience. Urology 2018;121:66–73.
12. Łukasz Dołowy, Wojciech Krajewski, Janusz Dembowski, Romuald Zdrojowy, and Anna Kołodziej. The role of lasers in modern urology. Central Eur J Urol 2015 June;68(2):175–182.
13. Kallidonis P, Amanatides L, Panagopoulos V, Kyriazis I, Vrettos T, Fligou F, et al. Does the heat generation by the thulium: Yttrium aluminum garnet laser in the irrigation fluid allow its use on the upper urinary tract? An experimental study. J Endourol 2016;30:422-7
14. Seisen T, Peyronnet B, Dominguez-Escrig JL, Bruins HM, Yuan CY, Babjuk M, et al. Oncologic outcomes of kidney-sparing surgery versus radical nephrourecterectomy for upper tract urothelial carcinoma: A systematic review by the EAU non-muscle invasive bladder cancer guidelines panel. Eur Urol 2016;70:1052-68.
15. Cutress ML, Stewart GD, Wells-Cole S, Phipps S, Thomas BG, Tolley DA. Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJU Int 2012;110:1608-17.
16. Musi G, Mistretta FA, Marenghi C, Russo A, Catellani M, Nazzani S, et al. Thulium laser treatment of upper urinary tract carcinoma: A multi-institutional analysis of surgical and oncological outcomes. J Endourol 2018;32:257-63.
17. Mohapatra A, Strope SA, Liu N et al. Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management. Int Urol Nephrol 2020;52:1465.
18. Defdio LD, De Dominicis M, Calarco A, et al. Is it possible and safe to treat endoscopically upper tract urothelial carcinoma larger than one centimeter? Eur Urol Suppl 2018;17(4).
19. Chieng Hin et tal. Role of ureteroscopy in treatment of upper tract urothelial carcinoma. Curr Urol Rep 2021;22:49
20. Roupret M, Babjuk M, Burger M, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma:2020 update. Eur Urol. 2021;79(1):62-7