Category: Laparoscopy: Upper Tract - Malignant

Introduction & Objective :

Radical nephro-ureterectomy (RNU) is the standard treatment of upper tract urothelial carcinoma (UTUC). Despite that, an endourological approach may be considered in imperative cases. We present the case of a patient who underwent conservative treatment for multiple high grade UTUC.

Methods :

Explorative rigid ureteroscopy and flexible ureteroscopy (fURS) (K. Storz) were performed in order to detect the lesions. IMAGE1 S™ (Karl Storz) technology increases dynamic contrast of the lesions. Real-time confocal laser endomicroscopy (CLE) with Cellvizio System® provided in vivo microscopic evaluation of the tissue lesions using a low-energy laser light source. Therefore, biopsies were taken using 3 devices: Piranha, Bigopsy (COOK), and 2.2 Fr Nitinol Baskets. Tumor ablation using holmium (30 W-COOK) and thulium (Revolix – Lisa Laser) was performed.

Results :

The age of the patient was 83 with past medical history of high grade (HG) bladder cancer and a functional solitary kidney. Multiple lesions (mean diameter 1.5 cm) were pre-operatively identified at CT scan. Pre-operative serum creatinine and GFR were 1.18 mg/dl and 40 ml/min/1.73 m² respectively.  Cellvizio® characterized the lesions as high grade UTUC. A total of 7 biopsies were taken; all the specimens were positive for HG UTUC at the final histopathological results. Cellvizio® found correspondence between the CLE images and the histopathological results. Serum creatinine was 1.40 mg/dl and GFR was 38 ml/min/1.73 m² on postoperative day 7. Postoperative drop of hemoglobin to 8.5 required two units of blood and patient recovered fine. CT scan at two months follow-up was negative for recurrence.

Conclusions :

Multiple and/or high-grade UTUC may be treated endoscopically in patients with imperative indications, particularly in old population. The combination of holmium and thulium laser allows a satisfactory ablation of UTUC. Due to the high risk of tumor recurrence and progression, a strict follow-up is mandatory.

Presenting Author(s)

• 

  Alberto Breda

  – Barcelona, Catalonia, Spain

Author(s)

• 

  Angelo Territo

  – licata, Sicilia, Italy
• GB

  Giuseppe Basile

  – Reggio Calabria, Calabria, Italy
• HV

  Helena Vila-Reyes

  – Barcelona, Catalonia, Spain
• JG

  Jose maria Gaya

  – Barcelona, Catalonia, Spain
• 

  Joan Palou

  – Chairman of Urology Departmentt at Fundacio Puigvert. Chair of the European School of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain, Barcelona, Catalonia, Spain