Laser en-bloc resection of solitary papillary tumors in the upper urinary tract - Description of the technique using a Thulium:YAG-Laser
S. Jutzi1, M.W. Kramer2, M. Wolters2, M.A. Kuczyk2, F. Imkamp2, T.R. Herrmann2
1MH Hannover, Hannover, Germany, 2MH Hannover, Klinik für Urologie und Urologische Onkologie, Hannover, Germany
Introduction: Transitional cell cancer is the fourth most frequent carcinoma. In only 5-10 %, the upper urinary tract is affected.An affection of the renal pelvis is observed twice as often as of the ureter. In conformity with the EAU Guidelines for TCC of theUUT, the radical nephroureterectomy is still the gold standard treatment. The demographic change leads to older patients withmore comorbidities and decreased renal function or functional or anatomical single kidneys. In this video we present the en-blocresection technique of a localized, solitary papillary tumor in the upper urinary tract using a Thulium:Yag-Laser.
Methods: A standard white-light flexible ureteroscopy was performed using a 7.5 F Uretero-Fiberscope. An access sheath of11/13 F x 36 cm was used to allow safe navigation through the ureter. The tumor in the pyeloureteral junction was en-blocresected with a Thulium:YAG-Laser and a 365µm fiber. The tumor was extracted with a 1,9F Zero Tip Nitinol basket. Cold cutbiopsies were taken from the tumor ground with a flexible biopsy forceps. Subsequently the tumor ground was coagulated withlaser energy. Afterwards a 6 F DJ-ureteral-catheter was inserted.
Results: The inserted DJ-catheter was removed 14 days after discharge. The histopathological analysis indicated a pTa G1Tumor. It was resected „en bloc“ without positive margins of the specimen. The cold cut biopsies show no residual tumor cells.Since surgery kidney function is approximately normal.
Conclusions: The en-bloc resection of solitary low-grade papillary tumors of the upper urinary tract using a Thulium:YAGLaser,might be a feasible treatment option in the hands of experienced endourologists.