Mp69-13 holmium:yag versus thulium:yag laser in endoscopic ablation of upper tract urothelial carcinoma: a comparison on perioperative outcomes and short-term follow-up

You have accessJournal of UrologyCME1 Apr 2023MP69-13 HOLMIUM:YAG VERSUS THULIUM:YAG LASER IN ENDOSCOPIC ABLATION OF UPPER TRACT UROTHELIAL CARCINOMA: A COMPARISON ON PERIOPERATIVE OUTCOMES AND SHORT-TERM FOLLOW-UP Elena Morini, Davide Perri, Umberto Besana, Federica Mazzoleni, Andrea Pacchetti, Lorenzo Berti, Matteo Corinti, Maria Chiara Sighinolfi, Bernardo Rocco, Salvatore Micali, Javier Romero Otero, Jean Baptiste Roche, Antonio Luigi Pastore, and Giorgio Bozzini Elena MoriniElena Morini More articles by this author , Davide PerriDavide Perri More articles by this author , Umberto BesanaUmberto Besana More articles by this author , Federica MazzoleniFederica Mazzoleni More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Lorenzo BertiLorenzo Berti More articles by this author , Matteo CorintiMatteo Corinti More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Javier Romero OteroJavier Romero Otero More articles by this author , Jean Baptiste RocheJean Baptiste Roche More articles by this author , Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , and Giorgio BozziniGiorgio Bozzini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Holmium-YAG (Ho:YAG) laser is the most widely used laser in urology for both the treatment of stones and soft tissues. However, the Thulium-YAG (Tm:YAG) laser has become a reliable alternative for soft tissue treatment. The aim of our study is to increase evidence on the safety and efficacy of endoscopic management of upper tract urothelial carcinoma (UTUC) with the Ho:YAG and Tm:YAG lasers. METHODS: 111 patients with a diagnosis of low-risk UTUC were enrolled. Exclusion criteria comprised patients with a bilateral or multifocal disease and use of antiplatelet/anticoagulant therapy. In all cases a preoperative computed tomography (CT) scan was performed with evidence of contrast-enhanced solid tissue inside the upper urinary tract. In all cases indication to ureteroscopy was given to confirm diagnosis and to perform biopsy. Endoscopic laser ablation was decided with respect to EAU guidelines recommendations: unifocal disease, tumor size <2 cm, negative or low-grade cytology, low-grade biopsy and no invasive aspect on CT. Laser ablation was performed with Tm:YAG and Ho:YAG in 62 (Group A, 55.9%) and 49 (Group B, 44.1%) patients respectively. Three months after surgery CT scan and ureteroscopy were performed. Afterwards, CT scan was performed every 6 months. RESULTS: Mean tumor size was 18.1 mm. Tumor was localised in the renal calyxes in 30 cases (27.0%), in the renal pelvis in 41 cases (37.0%) and inside the ureter in 40 cases (36.0%). Preoperative features were comparable between the two groups. Mean operative time was 18.2 min and 21.7 min in Groups A and B respectively (p=0.09). Mean haemoglobin drop at first postoperative day was 0.8 g/dl and 0.6 g/dl in Groups A and B (p=0.10). However, despite haemoglobin drop was not significantly different between the two treatments, a more consistent bleeding and a lower visibility were subjectively reported with the use of holmium laser. At a median follow-up of 42.3 months we observed a local recurrence in 12 patients (19.3%) in Group A and 18 (36.7%) patients in Group B (p=0.02). CONCLUSIONS: Despite perioperative outcomes were comparable between groups, a higher recurrence rate was observed after UTUC ablation with Ho:YAG laser. Lower intraoperative bleeding and better intraoperative vision were subjectively reported during surgery. These features along with a higher vaporisation effect with Tm:YAG laser may explain our results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e969 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elena Morini More articles by this author Davide Perri More articles by this author Umberto Besana More articles by this author Federica Mazzoleni More articles by this author Andrea Pacchetti More articles by this author Lorenzo Berti More articles by this author Matteo Corinti More articles by this author Maria Chiara Sighinolfi More articles by this author Bernardo Rocco More articles by this author Salvatore Micali More articles by this author Javier Romero Otero More articles by this author Jean Baptiste Roche More articles by this author Antonio Luigi Pastore More articles by this author Giorgio Bozzini More articles by this author Expand All Advertisement PDF downloadLoading ...