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Giulioni C, Pirola GM, Maggi M, Brocca C, Tramanzoli P, Stramucci S, Mantovan M, Perpepaj L, Cicconofri A, Gauhar V, Galosi AB, Castellani D. Current Evidence on Utility, Outcomes, and Limitations of Endoscopic Laser Ablation for Localized Upper Urinary Tract Urothelial Carcinoma: Results from a Scoping Review. EUR UROL SUPPL 2024; 59:7-17. [PMID: 38298767 PMCID: PMC10829601 DOI: 10.1016/j.euros.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/02/2024] Open
Abstract
Context The occurrence of upper urinary tract urothelial carcinoma (UTUC) is uncommon and is usually identified at an advanced and multifocal stage. Currently, there is growing interest in utilizing endoscopic laser ablation (ELA). Objective To evaluate the survival rates and perioperative complications of ELA. Evidence acquisition We performed a literature search through PubMed, Web of Science, and Scopus. The analysis included observational studies that examined the oncological outcomes of patients with UTUC treated with ELA. Evidence synthesis Neodymium and diode lasers are no longer used due to their high complication rates. Holmium:yttrium-aluminum-garnet (YAG) and thulium:YAG lasers provided excellent tumor ablation and hemostasis in both the collecting system and the ureter. These lasers offer good disease-free and cancer-specific survival, especially for low-grade tumors. Conclusions Advancements in laser technology and ablation techniques, and understanding of UTUC tumor biology hold significant promise in improving the use of conservative UTUC treatment, with excellent safety and good oncological outcomes for low-grade diseases. Patient summary With the advancement of technology, the conservative approach utilizing endoscopic laser ablation for upper tract urothelial tumors has been proved to be both safe and effective, showcasing promising survival rates.
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Affiliation(s)
- Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | | | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Carlo Brocca
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Pietro Tramanzoli
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Stramucci
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Mantovan
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Leonard Perpepaj
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Cicconofri
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
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Jiang D, Liu G, Yang B, Niu H, Fan H, Ren Z, Mu L, Xu X, Qiao X, Wu K, He D. 450-nm blue diode laser: a novel medical apparatus for upper tract urothelial lesions. World J Urol 2023; 41:3773-3779. [PMID: 37833548 PMCID: PMC10693503 DOI: 10.1007/s00345-023-04647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety and effectiveness of the 450-nm blue diode laser (BL), novel blue laser in the treatment of upper tract urothelial carcinomas (UTUCs) and other lesions in a porcine model. MATERIAL AND METHODS For in vitro experiment, the ureter tissue was vaporised and coagulated with BL, green-light laser (GL) and Ho:YAG laser (Ho). The efficiency, width and depth of vaporisation, and depth of coagulation were recorded and compared. For in vivo experiments, four swines weighing 70 kg were used. In the acute group, different modes of operations were performed to evaluate the thermal damage, perforation and bleeding. In the chronic group, the overall appearance of the ureter and laser wound healing were observed by the naked eyes and H&E staining 3 weeks after surgery. RESULTS In in vitro study, the BL showed a higher efficiency of tissue vaporisation and less tissue coagulation for fresh ureter compared to GL and Ho. In the in vivo study, the power of BL set at 7 W was better, and the thickness of thermal damage varied with different surgery types in the range of 74-306 μm. After 3 weeks, the wound healed well static in vaporisation (SV), moving vaporisation (MV) and H&E staining indicated mucosal healing rather than scar healing. CONCLUSION 5-10W blue diode laser achieved a higher efficiency of tissue vaporisation and less tissue coagulation in a porcine model, indicating its potential application in the endoscopic surgery of UTUC as an optional device with high performance and safety.
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Affiliation(s)
- Dali Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Guoxiong Liu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Bing Yang
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Haoming Niu
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Hengtong Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Zejun Ren
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Liyue Mu
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Xiaofeng Xu
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Ximin Qiao
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China.
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China.
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Ghoreifi A, Sari Motlagh R, Fuchs G. Modern Kidney-Sparing Management of Upper Tract Urothelial Carcinoma. Cancers (Basel) 2023; 15:4495. [PMID: 37760465 PMCID: PMC10526335 DOI: 10.3390/cancers15184495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE To review the latest evidence on the modern techniques and outcomes of kidney-sparing surgeries (KSS) in patients with upper tract urothelial carcinoma (UTUC). METHODS A comprehensive literature search on the study topic was conducted before 30 April 2023 using electronic databases including PubMed, MEDLINE, and EMBASE. A narrative overview of the literature was then provided based on the extracted data and a qualitative synthesis of the findings. RESULTS KSS is recommended for low- as well as select high-risk UTUCs who are not eligible for radical treatments. Endoscopic ablation is a KSS option that is associated with similar oncological outcomes compared with radical treatments while preserving renal function in well-selected patients. The other option in this setting is distal ureterectomy, which has the advantage of providing a definitive pathological stage and grade. Data from retrospective studies support the superiority of this approach over radical treatment with similar oncological outcomes, albeit in select cases. Novel chemoablation agents have also been studied in the past few years, of which mitomycin gel has received FDA approval for use in low-risk UTUCs. CONCLUSION KSSs are acceptable approaches for patients with low- and select high-risk UTUCs, which preserve renal function without compromising the oncological outcomes.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, CA 90089, USA;
| | | | - Gerhard Fuchs
- Institute of Urology, University of Southern California, Los Angeles, CA 90089, USA;
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Shvero A, Carmona O, Zilberman DE, Dotan ZA, Haifler M, Kleinmann N. Strategies of Endoscopic Management of Upper Tract Urothelial Carcinoma among Endourologists: A Global Survey. J Pers Med 2023; 13:jpm13040591. [PMID: 37108977 PMCID: PMC10143047 DOI: 10.3390/jpm13040591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Up-to-date guidelines on the management of upper tract urothelial carcinoma (UTUC) are continuously published. We aim to assess the variability of diagnosis and treatment strategies in the endoscopic management of UTUC and adherence to European Association of Urology and National Comprehensive Cancer Network guidelines. A 15-question survey was designed to query practitioners on approaches to clinical practice and knowledge about endoscopic treatment indications and techniques. It was emailed to all members of the Endourologic Society through the society’s office, and to all Israeli non-member endourologists. Eighty-eight urologists participated in the survey. Adherence to guidelines on indications for endoscopic management was only 51%. Most of the survey respondents (87.5%) use holmium laser for tumor ablation, and ~50% use forceps for biopsy while the other half use baskets. Only 50% stated that they would use Jelmyto® for specific indications. Most (80%) indicated that they repeat the ureteroscopy 3 months after the first one, and 52.3% continue with follow-up ureteroscopy every 3 months during the first year after diagnosis. There is vast variability among endourologists in the technical aspects of UTUC, the indications for endoscopic management, and adherence to the available guidelines for managing UTUC.
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Affiliation(s)
- Asaf Shvero
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-5303893
| | - Orel Carmona
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit E. Zilberman
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Zohar A. Dotan
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Miki Haifler
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nir Kleinmann
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Taratkin M, Singla N, Babaevskaya D, Androsov A, Shariat SF, Fajkovic H, Baniel J, Enikeev D. A Review of How Lasers Are Used in UTUC Surgery: Can the Choice of Laser Affect Outcomes? Cancers (Basel) 2023; 15:cancers15061874. [PMID: 36980763 PMCID: PMC10047311 DOI: 10.3390/cancers15061874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Upper tract urothelial carcinoma (UTUC) is a relatively rare disease with an aggressive phenotype compared to urothelial carcinoma in the bladder. In recent years, kidney-sparing surgery (KSS) and, in particular, endoscopic surgery have become the procedure of choice among urologists where the treatment of localized UTUC is concerned. Endoscopy tends to result in satisfactory oncological disease control while lowering morbidity and minimizing complications amongst the appropriately selected cohort of patients. While endoscopic surgery for UTUC might appear to be standardized, it, in fact, differs considerably depending on the source of energy used for resection/ablation. There has been little reliable data up to now on which laser energy source is the most superior. The goal of this review is, therefore, to outline the results of endoscopic UTUC treatment using different lasers and to analyze how these laser-tissue interactions may affect the surgery. We start by pointing out that the data remains insufficient when trying to determine which laser is the most effective in the endoscopic management of UTUC. The ever-growing number of indications for minimally invasive treatment and the increasing number of centers using laser surgery will, hopefully, lead to novel randomized controlled trials that compare the performance characteristics of the lasers as well as the effects of UTUC on patients.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
| | - Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Diana Babaevskaya
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
| | - Alexander Androsov
- Institute for Clinical Medicine, Sechenov University, 119021 Moscow, Russia
| | - Shahrokh F Shariat
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
- Department of Urology, Medical University of Vienna, 1030 Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Division of Urology, Department of Special Surgery, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
- Department of Urology, Second Faculty of Medicine, Charles University, 150 06 Prague, Czech Republic
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, 1030 Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, 3100 Vienna, Austria
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petach Tikva 4920232, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
- Department of Urology, Medical University of Vienna, 1030 Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, 3100 Vienna, Austria
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Kolvatzis M, Sierra Del Rio A, Corrales M, Traxer O. Stiff Guidewires in Endourology. What is stifness? J Endourol 2022; 36:1475-1482. [PMID: 35801659 DOI: 10.1089/end.2022.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION To perform a literature review of Stiff guidewires used in urology and to investigate if there is an official definition concerning the stiffness (shaft rigidity)of wires. MATERIALS AND METHODS A literature research was performed for all English written articles using database MEDLINE, Scopus, Google Scholar and the official websites of international companies. Guidewires from different companies were included. RESULTS We analyzed 14 different stiff guidewires from the companies Boston Scientific, Coloplast, Cook Medical, Olympus, Terumo, Rocamed and Bard Urological according to their characteristics. We found no concrete data regarding their stiffness on the official websites. In addition, there were few studies published about Amplatz Super Stiff (Boston Scientific), ZIP wire ™ Stiff Nitinol Hydrophilic (Boston Scientific), HiWire Stiff Nitinol Core Wire Guide (Cook Medical), Amplatz Fixed Core Wire Guide (Cook Medical) and Nicore TM nitinol Guidewire - Stiff (Bard Urological) whereas there were no available data for the majority of Stiff guidewires. CONCLUSION Stiff guidewires are listed in the catalogues of the companies without having any information for their classification. They are only divided to stiff and standard version without knowing the difference among them. The companies together with their manufacturers should adopt one common method in order to calculate and define stiffness of each guidewire.
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Affiliation(s)
| | - Alba Sierra Del Rio
- Hospital Clínic de Barcelona, 16493, Urology, Villarroel 170, Barcelona, Spain, 08036;
| | - Mariela Corrales
- Hospital Tenon, 55705, Urology, 4 Rue de la Chine, Paris, Île-de-France, France, 75020;
| | - Olivier Traxer
- Tenon Hospital, Assitance Publique-Hopitaux De Paris. Pierre Et Marie Curie University, Paris 6, Urology, 4 rue de la Chine, Paris, France, 75020;
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