Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center.
To evaluate ablative safety and efficacy of thulium-holmium:YAG (TL-HL:YAG) duo laser in renal conserving retrograde intrarenal surgery (RC-RIRS) in upper tract urothelial carcinoma (UTUC).  A retrospective study was performed on 178 consecutive patients referred for consideration of RC-RIRS UTUC-eLA (endoscopic laser ablation) in a tertiary center (January 2005 to December 2018). Key data were recorded using a standardized study proforma.  After endodiagnostic procedure, 42 declined rigorous endosurveillance protocol and went elsewhere for alternative treatment, leaving 136 patients, of whom 35 patients dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This was left with 101 candidates who continued UTUC conservative management (intention-to-treat [ITT] population). Mean follow-up (FU) for these 101 patients was 28.7 months. At last FU (range 3-144 months), 70 patients (69.3%) were recurrence free, 22 (21.8%) had endoscopically treated recurrences, and a further 9 (8.9%) had undergone RNU. In the ITT population, kidney-preserving rate was 91%, whereas in imperative indications, it was 87.5%. Clavien-Dindo grade I complications only (self-limiting hematuria) were reported in 10%.  Over a 13-year period, RC-RIRS UTUC treatment with the TL-HL:YAG duo laser was safe and oncologically noninferior to alternative combination laser energy technologies used for this indication.
['Defidio|Lorenzo|L|', 'Antonucci|Michele|M|', 'De Dominicis|Mauro|M|', 'Fuchs|Gerhard|G|', 'Patel|Anup|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002295:Carcinoma, Transitional Cell D000072700:Conservative Treatment D018572:Disease-Free Survival D005260:Female D006695:Holmium D006801:Humans D007668:Kidney D007680:Kidney Neoplasms D007682:Kidney Pelvis D053685:Laser Therapy D053844:Lasers, Solid-State D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D000074682:Nephroureterectomy D059351:Organ Sparing Treatments D011183:Postoperative Complications D012189:Retrospective Studies D062606:Tertiary Care Centers D013932:Thulium D018666:Ureteroscopy D055815:Young Adult
laser upper tract urothelial UTUC RIRS thulium