Experts' recommendations in laser use for the treatment of upper tract urothelial carcinoma: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training Research in Urological Surgery and Technology (T.R.U.S.T.) group.
World J Urol
; 41(11): 3367-3376, 2023 Nov.
Article
em En
| MEDLINE
| ID: mdl-37777981
ABSTRACT
PURPOSE:
To highlight and compare experts' laser settings during endoscopic laser treatment of upper tract urothelial carcinoma (UTUC), to identify measures to reduce complications, and to propose guidance for endourologists.METHODS:
Following a focused literature search to identify relevant questions, a survey was sent to laser experts. We asked participants for typical settings during specific scenarios (ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous treatment). These settings were compared among the reported laser types to find common settings and limits. Additionally, we identified preventive measures commonly applied during surgery.RESULTS:
Twenty experts completed the survey, needing a mean time of 12.7 min. Overall, most common laser type was Holmium-Yttrium-Aluminum-Garnet (HoYAG) (70%, 14/20) followed by Thulium fiber laser (TFL) (45%, 9/20), pulsed Thulium-Yttrium-Aluminum-Garnet (TmYAG) (3/20, 15%), and continuous wave (cw)TmYAG (1/20, 5%). Pulse energy for the treatment of distal ureteral tumors was significantly different with median settings of 0.9 J, 1 J and 0.45 J for HoYAG, TFL and pulsed TmYAG, respectively (p = 0.048). During URS and RIRS, pulse shapes were significantly different, with HoYAG being used in long pulse and TFL in short pulse mode (all p < 0.05). We did not find further disparities.CONCLUSION:
HoYAG is used by most experts, while TFL is the most promising alternative. Laser settings largely do not vary significantly. However, further research with novel lasers is necessary to define the optimal approach. With the recent introduction of small caliber and more flexible scopes, minimal-invasive UTUC treatment is further undergoing an extension of applicability in appropriately selected patients.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Bexiga Urinária
/
Carcinoma de Células de Transição
/
Litotripsia a Laser
/
Lasers de Estado Sólido
Tipo de estudo:
Guideline
Limite:
Humans
Idioma:
En
Revista:
World J Urol
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Áustria