Successful endoscopic treatment using thulium YAG laser for multiple ureteral fibroepithelial polyps in a pediatric patient.

Introduction: Ureteral fibroepithelial polyps are extremely rare and cause ureteropelvic junction obstruction in the pediatric population. Recent advancements in endoscopic treatment, such as holmium:yttrium-aluminum-garnet laser, have created more options for practitioners to treat multiple ureteral fibroepithelial polyps cases. However, the use of holmium:yttrium-aluminum-garnet laser multilobulated ureteral fibroepithelial polyps may have technical difficulties. Case presentation: An 11-year-old boy with intermittent right flank pain revealed multiple ureteral fibroepithelial polyps approximately 3 cm long at the right ureteropelvic junction. The ureteral fibroepithelial polyps were resected using flexible ureteroscopy using thulium:YAG laser. A second-look ureteroscopy revealed no recurrence, residual polyps, or ureteral stricture. At 1-year follow-up, ultrasonography showed no hydronephrosis on the affected side. Conclusion: Thulium:YAG laser provides clear visibility due to its high hemostatic and evaporation effects. To the best of our knowledge, this is the first pediatric case of multiple ureteral fibroepithelial polyps successfully treated with endoscopic resection using thulium:YAG laser, with a favorable clinical outcome.

Photodynamic Diagnosis-guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes.

BACKGROUND: Although ureteroscopic surgery (URS) is beneficial for low-risk upper urinary tract carcinoma (UTUC), there is no standardized URS technique or navigation system for challenging cases. OBJECTIVE: To present a URS technique for UTUC using thulium (Tm):YAG and holmium (Ho):YAG lasers under photodynamic diagnosis (PDD) guidance, named PDD-guided dual laser ablation (PDD-DLA) and compare its efficacy with that of conventional Ho:YAG laser ablation (HLA; historical control). DESIGN SETTING AND PARTICIPANTS: The study included ten consecutive UTUC patients who underwent PDD-DLA between 2017 and 2019. The control group comprised 16 consecutive patients who underwent HLA between 2006 and 2016. SURGICAL PROCEDURE: After oral administration of 5-aminolevulinic acid (20 mg/kg), UTUC tumors were endoscopically resected via PDD-DLA. MEASUREMENTS: Clinical data were prospectively collected for our institutional UTUC data set. Disease progression, UTUC recurrence, and clinical outcomes were assessed. RESULTS AND LIMITATIONS: PDD-DLA was successfully performed in all patients. The median tumor size was 23.5 mm (interquartile range [IQR] 12.8-30.0) and there were four cases (40.0%) of high-grade tumor. The median operative time was 120 min (IQR 98.5-142.5). No Clavien-Dindo grade ≥3 complications were observed. There were no differences in most clinical characteristics between the PDD-DLA and HLA groups. The 2-yr progression-free survival rate was 100% in the PDD-DLA group and 58.7% in the HLA group (p = 0.0197), and the 2-yr recurrence-free survival rate was 57.1% and 41.3%, respectively (p = 0.072). The PDD-DLA group had a lower incidence rate of salvage RNU compared with the HLA group (0.0% vs 50%; p = 0.009). The small sample size might affect the reproducibility of these results. CONCLUSIONS: PDD-DLA seems to be an effective and feasible endoscopic technique for UTUC treatment with favorable oncological outcomes. PATIENT SUMMARY: We investigated a new laser technique for treating cancer of the upper urinary tract called photodynamic diagnosis-guided dual laser ablation. Our strategy was effective in removing tumors and stopping bleeding. Further studies in larger groups of patients are needed to confirm whether this technique improves cancer outcomes.

Examining the Impact of Different Properties of Ureteral Access Sheaths in Reducing Insertion Force During Retrograde Intrarenal Surgery: An In Vitro Study.

Background and Purpose: This study aimed to evaluate the characteristics of ureteral access sheaths (UASs) that can reduce the insertion force while accessing the upper urinary tract. Materials and Methods: Six different types of 12/14F UASs were used. We evaluated the properties of UASs such as the diameter of the outer sheath, length of the inner dilator tip exposed from the outer sheath, sheath flexibility (assessed in terms of bending force of the tip or base), flexibility ratio (i.e., bending force value of tip-to-base ratio), and frictional force of the outer sheath surface. We measured the force required for inserting the UAS into an artificial ureteral model and examined the correlation between the relevant characteristics and insertion force for each UAS. Results: Overall, a lower tip-to-base flexibility ratio (r = 0.66) and a lower frictional force (r = 0.50) were inversely correlated with insertion force. The force of insertion into the bifurcation was associated with the flexibility of the base (r = -0.64), flexibility ratio (r = 0.79), and frictional force (r = 0.66). Moreover, a shorter dilator tip (r = 0.52), lower flexibility ratio (r = 0.52), and lower frictional force (r = 0.50) were correlated with a lower insertion force at the proximal ureter. Conclusion: A UAS with a rigid base and flexible tip parts, a smoother surface, and a shorter dilator tip would be preferable for reducing the insertion force. These findings may be crucial for selecting or developing an ideal UAS that can decrease the risk of ureteral injury.

Complete intraureteral stent placement relieves daytime urinary frequency compared with conventional placement in patients with an indwelling ureteral stent: post-hoc analysis of a randomized, controlled trial.

A previous randomized, controlled trial had demonstrated that complete intraureteral stent placement (CIU-SP) was superior to conventional stent placement (C-SP) in terms of improvement of stent-related urinary symptoms. However, it is unclear as to which subdomain symptom and cohort could benefit the most from CIU-SP compared to C-SP in urinary symptoms while considering the baseline urinary status. To determine this, a post-hoc analysis was performed using data from a previous study (CIU-SP group, n = 39; C-SP group, n = 41). We assessed the mean changes in the International Prostate Symptom Score (I-PSS) and the Overactive Bladder Symptom Score (OABSS) from baseline to day 14. Statistical comparison between the two groups was performed using analysis of covariance with adjustment of baseline urinary status as a covariate. Among 80 patients, the total I-PSS was significantly lower in the CIU-SP group than in the C-SP group in the cohort with mild urinary symptoms (P = 0.005), but not in those with moderate/severe symptoms (P = 0.521). The CIU-SP group showed significantly improved I-PSS and OABSS daytime frequencies, with the highest t statistic (2.47 and 2.10, respectively) among subdomains of both symptom scores compared with the C-SP group (both P < 0.001). In multivariate regression analysis, the stent placement method (CIU-SP vs. C-SP) was independently associated with the I-PSS daytime frequency on day 14 (P = 0.017). This study suggests that CIU-SP significantly improved stent-related daytime frequency compared with C-SP, and it may benefit especially those patients who have mild urinary symptoms before the placement of ureteral stents.