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In medio stat virtus: Exploring the potential of the pulsed thulium:YAG laser in the endoscopic management of upper tract urothelial carcinoma

S. Proietti,F. De Leonardis,Cristian Axel Hernandez Gaytan,Rebeca Escobar Monroy,S. Gisone,R. Scalia,Franco Gaboardi,G. Giusti

Published 2025 in Central European Journal of Urology

ABSTRACT

Introduction The pulsed thulium:YAG (p-Tm:YAG) laser has shown encouraging results in the management of stone disease and BPH; however, its application in the endoscopic management of upper tract urothelial carcinoma (UTUC) has not yet been clinically investigated. The aim of this study is to evaluate the effectiveness and safety of the p-Tm:YAG laser in the endoscopic management of UTUC. Material and methods Retrospective data were collected from all patients who underwent endoscopic treatment for UTUC between January and April 2024. Eligible patients were those diagnosed with UTUC and deemed suitable for endoscopic management. Both low-grade and high-grade cases were included. All patients underwent a second-look procedure 2 months after the initial surgery, followed by endoscopic surveillance at 6 and 12 months postoperatively. The laser source used for tumor ablation and coagulation was the p-Tm:YAG laser. Results A total of 20 patients were included in the study. Among them, 12 patients (60%) were included in the low-risk UTUC conservative treatment group, while 8 patients (40%) were categorized into the high-risk group. At the time of the second procedure, histopathological analysis revealed no evidence of tumor in 16 cases (80%), while a tumor was identified in 4 patients (20%). No intraoperative complications were recorded. Postoperatively, 10 out of 75 procedures (13.3%) were associated with Clavien-Dindo grade I–II complications. No major complications occurred. Conclusions In short-term follow-up, the use of the p-Tm:YAG laser for endoscopic UTUC treatment has proven to be safe and effective.

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