Treatment of upper tract urothelial carcinoma with ureteroscopy and thulium laser: a retrospective single center study

Background: Treatment with the combination of ureteroscopy and thulium laser ablation may provide an alternative to radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC). The purpose of this study was to investigate the efficacy and safety of this technique. Methods: We performed a retrospective review of the data for patients who were treated surgically for upper tract urothelial carcinoma in a single center. It included 32 patients treated by endoscopic thulium laser resection and 107 patients treated by radical nephroureterectomy (RNU). We compared the data of patient sex, age at diagnosis, location of carcinoma, length of hospitalization, tumor site, size, grade, recurrence, preoperative creatinine and postoperative creatinine in two groups. Patients were examined by ureteroscopy every 3 months during the first year after surgery, then every 6 months each year. Results: All 32 patients were treated successfully, among which 6 were operated by a flexible ureteroscope. The average tumor size was 13 +/- 7 mm in diameter. The tumor was rated as low grade in 27 patients and high grade in 5 patients. Ureteral stricture developed in 4 patients 3 months later after surgery, but the stricture was succesfully treated through endoscopic dilation. Seven patients had tumor recurrence, 3 of which underwent nephroureterectomy during the follow-up. Postoperative creatinine levels (umol/L) were respectively 89 +/- 7.5 in laser group and 123 +/- 15.4 in RNU group (p < 0.01). Length of hospitalization was respectively 3.6 +/- 1.9 and 8.6 +/- 2. 4 days (p < 0.01). Local or bladder recurrence rate of thulium laser group and RNU group was respectively 21.9 and 13.1% (p < 0.01). Conclusions: Thulium laser group is associated with a less loss of renal function, a shorter length of hospitalization, but a higher rate of tumor recurrence. Thulium laser therapy combined with ureteroscopic treatment can be considered as an acceptable treatment for selected cases of UTUC. Lifetime intensive surveillance is necessary.