Category: Endoscopic

MP23-19 - Thulium SuperPulse Fiber Laser (TSPFL) in the endourological management of upper urinary tract urothelial carcinoma (UTUC).

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Endourological treatment of UTUC often represents clinical dilemma due to their high recurrence rate and necessity of thorough endoscopic follow-up. Introduction into clinical practice of Thulium SuperPulse Fiber Laser (TSPFL) opens new possibilities in these difficult cases. This paper reports on our initial clinical experience with thulium-fiber laser management of UTUC.


Methods :

Since November 2017, we have enrolled in this study 11 patients with UTUC, which have been managed ureteroscopically (rigid and flexible). Besides comorbidities, the indications for endourologic intervention included solitary kidney unit in 7 cases, compromised renal function in 3 cases, and bilateral pathology in one case. The tumor sizes varied from 1 to 4.5 cm. The location were upper calyx (3), middle calyx (1), pelvis (6), upper ureter (1). There were no signs of multifocality, but the history of bladder cancer was present in 6 of 11 cases. SPIES (5) or NBI (6) assisted ureteroscopies have been done in all cases with partial basketing of the tumor for debulking and pathology investigation. In 4 cases with the tumors larger than 2.5 cm the intervention was conducted in two sessions due to long time of intervention. Ureteral access sheaths were not used. The ureteroscopy times varied from 23 to 75 min. Transitional cell carcinoma G1 have been revealed in 8 patients, G2 - in 3 patients. TSPFL (wavelength 1.94nm) settings were: repetition rate 20-15 Hz, pulse energy 0.5-2.0 J,  power 10-30 W. Lasering time: 15-60 min. Ureteral stents have been placed in all cases. There were no major complications.


Results :

Follow-up examinations have been done at 3 and 6 months after intervention. There were no recurrences at the locations of initial tumors; however, in two cases tiny bladder lesions have been revealed and subsequently resected with TSPFL.


Conclusions : The initial data suggest thatTSPFL is a capable modality for fast and safe removal of UTUC. SPIES or NBI assisted ureteroscopies are justified. However, further clinical studies are required.     

Alexey G. Martov

Head of Urology department
Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Moscow, Russia
Moscow, Moskva, Russia

Martov Alexey G., MD, PhD, Honored Doctor of Russia
Professor and Chairman, Department of Urology, Federal Medico-biology Agency
Professor of Urology, Russian Medical Academy of Postgraduate Education
Head of Urology Department, Moscow City Hospital № 57
Ph/fax: +7 499 7800853
e-mail: martovalex@mail.ru
www.amartov.ru

1978-1982. First Moscow Medical Institute
1982-1988. Residenship, Institute of Urology, Moscow
1988. Doctorate Thesis «Percutaneous Treatment of Kidney Stones»
1988-2006. Institute of Urology, from Head of Endourology Department to Vice-President
1993. PhD degree, «Endourological Treatment of Upper Urinary Tract Diseases»
2006 – p. t. Head of Urology Department, Moscow City Hospital №57, Professor of Urology, Russian Medical Academy of Postgraduate Education
2012 – p.t. Professor and Chairman Department of Urology, Federal Medico-biology Agency, Russia


Activities
• Founding Member and President of the Russian Endourology and New Urotechnology Society
• Vice-president of the Russian Urology Association
• Co-Editor of Russian Journal “Urology”
• Member of EAU, SIU, AUA, Endourological Society
• CROES, ESUT activity
• Director of Training Center for Endourology, Moscow, Russia
• Honorary member of Russian, Georgian and Azerbaijan Urology Association
Specialisations / Interests
• Endourology
• BPH
• Stone desease
• Urooncology

over 400 scientific publications (PubMed-cited Journals), 15 books, 35 books chapters
3 educational CD for Urologists (Endourology, BPH, Prostate cancer)
Numerous international invitations for live surgery meetings / presentations / workshops / congresses and teaching events in Russia and countries of former Soviet Union, Germany, France, Austria, Switzerland, Turkey, Sweden etc.
Moscow, 2018

Dmitry V. Ergakov

Associate Professor
Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Pletnews Municipal Hospital, Moscow, Russia
Moscow, Moskva, Russia

Ivan Solomatnikov

Andrey Andronov

Moscow, Moskva, Russia