Initial experience of flexible ureteroscopy combined with thulium laser for the treatment of upper urinary tract urothelial carcinoma
10.3760/cma.j.issn.1000-6702.2019.09.003
- VernacularTitle: 输尿管软镜联合铥激光治疗上尿路尿路上皮癌的初步经验
- Author:
Shaoxiong MING
1
;
Yonghan PENG
;
Ling LI
;
Zeyu WANG
;
Ziyu FANG
;
Fei XIE
;
Chaoyue LU
;
Rong SHEN
;
Xiaofeng GAO
Author Information
1. Department of Urology, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
- Publication Type:Clinical Trail
- Keywords:
Ureteroscopy;
Flexible ureteroscope;
Thulium laser;
Upper urinary tract urothelial carcinoma
- From:
Chinese Journal of Urology
2019;40(9):650-653
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the initial experience of flexible ureteroscopy combined with thulium laser for the treatment of high-risk upper urinary tract urothelial carcinoma (UTUC) in patients with solitary kidney or renal insufficiency.
Methods:A retrospective analysis was performed in 5 cases of UTUC with solitary kidney or renal insufficiency treated via flexible ureteroscopy combined with thulium laser from May 2016 to November 2018. Patients consisted of 4 cases of left side tumor, 1 case of right side tumor, with median age of 73 years old(ranging 53-87 years old). Among the 5 cases, 3 were solitary kidney with renal pelvis tumors, 2 cases were renal insufficiency accompanied with proximal ureter or renal pelvis tumor. All the patients had tumors large than 2 cm in diameter. The creatine in 3 cases with solitary kidney was 102, 128, 143μmol/L, respectively. The creatine in 2 cases with renal insufficiency was 281, 179μmol/L, respectively. Variable hydronephrosis was noticed in all paients. The cytological examination could reveal tumor cells in all cases. During the operation, part of tumor tissues were resected for pathological examination and the remaining visible tumor tissue was all ablated and vaporized. As there was no obvious residual tumor tissue, double J stent was retained. Patients were regularly reexamined after surgery.
Results:Of the 5 cases, 4 patients were successfully performed, while intraoperative bleeding occurred in 1 case. The operation was suspended after indwelling double J stent. Then, the renal artery interventional embolism was performed after ineffective conservative treatment, and the bleeding was well controlled. One month later, the patient was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again. The pathology of all cases was high-grade invasive urinary epithelial carcinoma. Patients were followed up with regular imaging and endoscopic examination. The median follow-up period was 19 (4-26) months, during which 4 cases had local recurrence, one patient died of non-tumor factors. No recurrence of urothelial carcinoma occurred in the bladder during follow-up, the overall recurrence rate was 80%, and the median recurrence time was 6 (1-24) months. Patients with recurrence was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again.
Conclusions:Flexible ureteroscopy combined with thulium laser is an alternative treatment for high-risk upper urinary tract urothelial carcinoma in patients with solitary kidney or renal insufficiency, while with high tumor recurrence rate. Therefore, a stringent imaging and endoscopic follow-up should carry out postoperatively.
