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.
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.
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.
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.
World journal of urology. 2023 Oct 01 [Epub ahead of print]
Gernot Ortner, Bhaskar Kumar Somani, Selcuk Güven, Gerhard Kitzbichler, Olivier Traxer, Guido Giusti, Silvia Proietti, Evangelos Liatsikos, Panagiotis Kallidonis, Øyvind Ulvik, Ioannis Kartalas Goumas, Mordechai Duvdevani, Joyce Baard, Guido M Kamphuis, Stefania Ferretti, Laurian Dragos, Luca Villa, Arkadiusz Miernik, Thomas Tailly, Amelia Pietropaolo, Saeed Bin Hamri, Athanasios Papatsoris, Ali Serdar Gözen, Thomas R W Herrmann, Udo Nagele, Theodoros Tokas
Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria. ., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England., Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey., Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria., Sorbonne University, GRC n°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France., Department of Urology, San Raffaele Hospital, Milan, Italy., Department of Urology, University of Patras, Patras, Greece., Department of Urology, Haukeland University Hospital, Bergen, Norway., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel., Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Department of Urology, Hospital and University of Modena, Modena, Italy., Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy., Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany., Department of Urology, University Hospital Ghent, Ghent, Belgium., Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia., 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany., Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.