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

Gernot Ortner^{1

2}, Bhaskar Kumar Somani³, Selcuk Güven⁴, Gerhard Kitzbichler⁵, Olivier Traxer⁶, Guido Giusti⁷, Silvia Proietti⁷, Evangelos Liatsikos⁸, Panagiotis Kallidonis⁸, Øyvind Ulvik⁹, Ioannis Kartalas Goumas¹⁰, Mordechai Duvdevani¹¹, Joyce Baard¹², Guido M Kamphuis¹², Stefania Ferretti¹³, Laurian Dragos¹⁴, Luca Villa¹⁵, Arkadiusz Miernik¹⁶, Thomas Tailly¹⁷, Amelia Pietropaolo³, Saeed Bin Hamri¹⁸, Athanasios Papatsoris¹⁹, Ali Serdar Gözen²⁰, Thomas R W Herrmann^{21

22}, Udo Nagele^{5

21}, Theodoros Tokas^{21

23}

Affiliations

¹ Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria. gerni_o@hotmail.com.
² Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria. gerni_o@hotmail.com.
³ Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England.
⁴ Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
⁵ Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria.
⁶ Sorbonne University, GRC n°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France.
⁷ Department of Urology, San Raffaele Hospital, Milan, Italy.
⁸ Department of Urology, University of Patras, Patras, Greece.
⁹ Department of Urology, Haukeland University Hospital, Bergen, Norway.
¹⁰ Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy.
¹¹ Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel.
¹² Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹³ Department of Urology, Hospital and University of Modena, Modena, Italy.
¹⁴ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁵ Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
¹⁶ Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁷ Department of Urology, University Hospital Ghent, Ghent, Belgium.
¹⁸ Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia.
¹⁹ 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²⁰ Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany.
²¹ Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
²² Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.
²³ Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece.

PMID: 37777981
DOI: 10.1007/s00345-023-04632-4

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

Gernot Ortner et al. World J Urol. 2023 Nov.

. 2023 Nov;41(11):3367-3376.

doi: 10.1007/s00345-023-04632-4. Epub 2023 Oct 1.

Authors

Affiliations

¹ Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria. gerni_o@hotmail.com.
² Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria. gerni_o@hotmail.com.
³ Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England.
⁴ Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
⁵ Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria.
⁶ Sorbonne University, GRC n°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France.
⁷ Department of Urology, San Raffaele Hospital, Milan, Italy.
⁸ Department of Urology, University of Patras, Patras, Greece.
⁹ Department of Urology, Haukeland University Hospital, Bergen, Norway.
¹⁰ Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy.
¹¹ Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel.
¹² Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹³ Department of Urology, Hospital and University of Modena, Modena, Italy.
¹⁴ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁵ Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
¹⁶ Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁷ Department of Urology, University Hospital Ghent, Ghent, Belgium.
¹⁸ Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia.
¹⁹ 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²⁰ Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany.
²¹ Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
²² Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.
²³ Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece.

PMID: 37777981
DOI: 10.1007/s00345-023-04632-4

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 (Ho:YAG) (70%, 14/20) followed by Thulium fiber laser (TFL) (45%, 9/20), pulsed Thulium-Yttrium-Aluminum-Garnet (Tm:YAG) (3/20, 15%), and continuous wave (cw)Tm:YAG (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 Ho:YAG, TFL and pulsed Tm:YAG, respectively (p = 0.048). During URS and RIRS, pulse shapes were significantly different, with Ho:YAG being used in long pulse and TFL in short pulse mode (all p < 0.05). We did not find further disparities.

Conclusion: Ho:YAG 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.

Keywords: Laser; Percutaneous; RIRS; URS; UTUC; Urothelial cancer.

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References

1. Rouprêt M, Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM et al (2021) European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2020 update. Eur Urol 79(1):62–79. https://doi.org/10.1016/j.eururo.2020.05.042 - DOI - PubMed
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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

Affiliations

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

Authors

Affiliations

Abstract

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical