532 nm green-light laser vaporization of upper tract urothelial carcinoma

Abstract

Background Endoscopic management of low risk upper tract urothelial carcinoma (UTUC) may be considered in select clinical scenarios, which allows sparing the morbidity of radical nephroureterectomy while achieving acceptable oncological outcomes and preservation of kidney function. Herein, we present a case with UTUC in a solitary kidney managed with 532 nm laser vaporization through a percutaneous approach. Case presentation The patient in this video (Additional file 1) is an 85-year-old woman who presented with a bulky tumor in the collecting system of a congenital solitary left kidney, which was a biopsy proven low grade urothelial carcinoma. Prior to the procedure, a lower pole percutaneous nephrostomy tube was successfully placed under sedation by Interventional Radiology. The procedure was done in a prone split leg position. The mass, which was predominantly localized to the renal pelvis was efficiently vaporized with the 532 nm laser in a systematic manner with continuous irrigation of normal saline through the cystoscope. The patient was discharged home on postoperative day 2 with the nephroureterostomy catheter open to drainage. This catheter was subsequently clamped and removed two weeks later without complications. Follow up uretroscopy showed excellent treatment response and the patient remains well without complications. Conclusion This case report details the potential utility of 532 nm laser vaporization of UTUC, however, ongoing studies are required to demonstrate peri-operative safety and durable oncologic efficacy.

Ureteroscopic Cryoablation for Patients with Upper Tract Urothelial Carcinoma of a Solitary Kidney: A Porcine Model and Our Pilot Clinical Experience

“… 1 Laser ablation remains the most dominant method among the kinds of endoscopic techniques applied so far. 1 , 10 These therapeutic options should also be considered for selected patients, for example, those with a solitary kidney, bilateral UTUC, and renal insufficiency, even in high-risk cases. It is regrettable that patients with high-grade disease often fare poorly in consideration of existing modalities.…”

A Review of How Lasers Are Used in UTUC Surgery: Can the Choice of Laser Affect Outcomes?

“…Ex vivo trials have shown deep coagulation and high vaporization effects at high-power settings [ 37 ]. These characteristics may make them candidates for vaporization of UTUC, but the significant coagulation depth of the Greenlight laser limits its usability for UTUC treatment, resulting in limited evidence regarding its efficiency [ 38 ].…”

“…However, the deep tissue effects of diode lasers and Nd:YAG theoretically might cause ureteral perforation and thus have to be applied carefully for the endoscopic treatment of UTUC. The experience of diode laser (T-1470 LiteTouch™) use for UTUC treatment is described mostly in case reports with promising reports regarding perioperative outcomes [ 38 , 42 ].…”

450-nm blue diode laser: a novel medical apparatus for upper tract urothelial lesions

“…According to previous studies, different kinds of lasers have been utilised in the treatment of UTUC, such as the 532-nm KTP laser, thulium laser (Tm:YAG) and holmium laser (Ho:YAG) [ 6 , 12 – 14 ]. The purpose of various laser studies and applications was to explore its feasibility, safety and effectiveness.…”