Effectiveness and Safety of Thulium Fiber Laser in the Conservative Management of Patients with Upper Tract Urothelial Carcinoma

Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma

“…Adequate irrigation outflow is essential for URS to achieve clear visibility and temperature control 82,83 . Two methods of irrigation, that is, automatic pump irrigation and gravity‐based irrigation, may be used 24–26 . The advantage of automatic pump irrigation over gravity‐based irrigation includes the ability to regulate the irrigation pressure objectively according to surgery conditions 84 .…”

“…Generally, a second‐look URS is scheduled 6–8 weeks after the initial ablation of a tumor to determine whether EM should be continued 23,25,26,94 . Villa et al 99 .…”

“…This laser can operate in either the super‐pulsed mode or quasi‐continuous mode 80 . Proietti et al 26 . recently reported the safety and feasibility of super‐pulsed TFL for the EM of UTUC.…”

“…It also facilitates the removal of tumor fragments with a basket without touching the ureteral and bladder mucosa, thus preventing the potential seeding of tumor cells and IVR 88 . The current default UAS sizes are 10/12 Fr 23,25,26 and 12/14 Fr 24 . The risks of UAS use include iatrogenic ureteral wall injury when using a 12/14 Fr UAS 89 and increased intrarenal pressure when performing URS with a diameter of ≥8 Fr and a 10/12 Fr UAS 85,87 …”

“…Although EM offers comparable cancer‐specific survival (CSS) and overall survival to those of RNU, especially in cases of low‐risk tumors, a higher rate of upper urinary tract recurrence (up to 90.5%) is a serious drawback, thus requiring long‐term rigorous surveillance and repeated interventions (Table 1). 6,9–28 This might be a reason why EM tends to be avoided compared with RNU. Therefore, advances in accurate patient selection, surgical procedures, and perioperative management are necessary to improve the oncological outcomes of EM.…”