International Braz J Urol最新文献

{"title":"Multicenter Retrospective Registry Study on BCG Use in Non-Muscle Invasive Bladder Cancer in Latin America: BLATAM (Bladder Cancer in Latin America) Group.","authors":"Gustavo M Villoldo, Matias Ignacio Gonzalez, Alvaro Vidal Faune, Ricardo Castillejos Molina, Fernando Meza Montoya, José Gadu Campos Salcedo, Gonzalo Vitagliano, Hamilton Zampolli, Alcedir Raiser Lima, Ruben Bengio, Juan J Camean, Germán Ándres Alfieri, Guido J P Escalante, Ivan Edgar Bravo Castro, Hernando Rios Pita, Juan Escuder, Francisco Rodriguez Covarrubias, Maria Fernanda Oliveira, Rafael Sanchez-Salas, Gabriel Andrés Favre, Eduardo Guevara, Esteban Arismendi Videla, Guillermo Martinez Delgado, Ignacio Tobia, Roberto F Villalba Bachur, Ana Maria Autran","doi":"10.1590/S1677-5538.IBJU.2024.0615","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0615","url":null,"abstract":"<p><strong>Objectives: </strong>This study, conducted by the Bladder Cancer in Latin America (BLATAM) group, aims to analyze epidemiological and therapeutic data on non-muscle invasive bladder cancer (NMIBC) in Latin American patients. It seeks to identify factors contributing to suboptimal responses to Bacillus Calmette-Guérin (BCG) therapy and assess areas for improvement in regional treatment practices.</p><p><strong>Materials and methods: </strong>A multicenter retrospective study was carried out in collaboration with reference Urology Departments across Latin America. Data were collected using an electronic Case Report Form (CRF) from 2011 to 2021, capturing demographics, clinical presentation, treatment details, and follow-up of NMIBC patients treated with BCG. Statistical analyses included Kaplan-Meier survival analysis for relapse-free survival (RFS).</p><p><strong>Results: </strong>Data from 292 patients across five countries were analyzed, with a mean age of 70.3 years and a male prevalence of 74%. Smoking history was reported in 70.6% of patients. The mean time to the first BCG dose was 2.4 months post-TURBT, with 26.7% of patients exceeding the recommended 60-day window for induction initiation. While 84% of patients completed BCG induction, only 45.9% followed the recommended Lamm maintenance schedule. Delays in starting maintenance cycles were observed, with a median delay of over 36 days for the first cycle and 65 days for the second cycle. RFS at 1 year and 5 years for high-risk patients was 87.3% and 53.3%, respectively.</p><p><strong>Conclusions: </strong>This study highlights critical deviations from recommended NMIBC management protocols in Latin America, including delayed BCG initiation and inconsistencies in maintenance therapy. These findings emphasize the need for standardized treatment protocols and improved adherence to international guidelines, which could enhance NMIBC patient outcomes in the region. Collaborative efforts are essential to develop region-specific strategies, improve data collection, and ultimately provide better care for bladder cancer patients in Latin America.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Urogram in Pediatric Urology: a Comprehensive Review of Applications and Advances.","authors":"Benjamin Press, Joo Cho, Andrew Kirsch","doi":"10.1590/S1677-5538.IBJU.2025.0047","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0047","url":null,"abstract":"<p><p>Magnetic Resonance Urography (MRU) has emerged as a powerful imaging modality in pediatric urology, offering comprehensive anatomical and functional assessment of the urinary tract without exposure to ionizing radiation. This review provides an in-depth analysis of MRU's technical aspects, clinical applications, advantages, and recent advancements. Traditional imaging techniques, such as ultrasound, voiding cystourethrography, and nuclear scintigraphy, have long been utilized for evaluating pediatric urinary tract anomalies; however, these methods have inherent limitations in anatomical resolution and functional assessment. MRU combines high-resolution anatomical imaging with dynamic functional analysis, making it particularly valuable in evaluating conditions such as hydronephrosis, ureteropelvic junction obstruction, and ectopic ureters. Advancements in MRU technology, including the use of 3T MRI for superior spatial resolution, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have enhanced its diagnostic capabilities. The ability to assess renal transit times and differential renal function allows for precise evaluation of obstructive uropathies and congenital anomalies. Despite requiring sedation in younger children and longer acquisition times, MRU has demonstrated superior accuracy compared to conventional imaging, reducing the need for multiple diagnostic studies. Recent developments in real-time MRI, faster imaging techniques, and AI-based reconstructions have further optimized MRU's efficiency and diagnostic utility. As MRU continues to evolve, its role in pediatric urology is expected to expand, potentially replacing traditional imaging modalities in select cases. This review highlights the growing significance of MRU in pediatric urinary tract evaluation, emphasizing its potential to improve clinical decision-making and patient outcomes.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Multiparametric Magnetic Resonance Imaging (T2-weighted Imaging and Apparent Diffusion Coefficient) for Pathological Grading of Prostate Cancer: a Meta-Analysis.","authors":"Subo Zhang, Jinxin Wan, Yongjun Xu, Leiming Huo, Lei Xu, Jiabao Xia, Zhitao Zhu, Jingfang Liu, Yan Zhao","doi":"10.1590/S1677-5538.IBJU.2024.0509","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0509","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aimed to evaluate the predictive value of multiparametric magnetic resonance imaging (mpMRI), specifically T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) maps, in the pathological grading of prostate cancer.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across multiple databases, including PubMed, the China National Knowledge Infrastructure dataset, Web of Science, Springer Link and Cochrane Library. Studies evaluating the use of mpMRI for prostate cancer grading were included. The quality of the included studies was assessed using the risk of bias tool. Meta-analyses were performed to calculate pooled areas under the curve (AUC) and prostate cancer detection rates.</p><p><strong>Results: </strong>Seven studies met the inclusion criteria, comprising 843 patients in the experimental group and 962 in the control group. The meta-analysis revealed a significant improvement in diagnostic performance with mpMRI, with a pooled mean difference in AUC of 0.10 (95% confidence interval [CI]: 0.04-0.16, p = 0.002) favouring the mpMRI group. The odds ratio for prostate cancer detection was 2.60 (95% CI: 1.57-4.29, p = 0.0002), indicating a higher detection rate with mpMRI compared with standard techniques. Substantial heterogeneity was observed among the studies (I² = 73% for AUC and 66% for detection rate).</p><p><strong>Conclusion: </strong>This meta-analysis demonstrates that mpMRI, particularly T2WI and ADC imaging, has a significant predictive value in the pathological grading of prostate cancer. The technique shows improved diagnostic accuracy and higher cancer detection rates compared with conventional methods. However, the substantial heterogeneity among studies suggests that standardisation of mpMRI protocols and interpretation criteria is needed.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative and quantitative characterization of the Rhesus monkey (Macaca mulatta) penis.","authors":"Marcelo Abidu-Figueiredo, Edilaine F Alves, Carla B M Gallo, Waldemar S Costa, Luciano A Favorito, Francisco J B Sampaio","doi":"10.1590/S1677-5538.IBJU.2025.9906","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9906","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of the anatomy of laboratory animals is important for experimental research. Erectile dysfunction has been studied using the penises of different laboratory animals such as rats, mice, rabbits, dogs, etc. However, these animals have penises with different characteristics to the human penis. If these differences are not taken into account, the conclusions may be questionable. The Rhesus monkey (Macaca mulatta), due to its similarities to humans, could be a good model.</p><p><strong>Objective: </strong>To characterize and quantify the components of the penis of the Rhesus monkey (Macaca mulatta), qualifying it as a model for experimental studies.</p><p><strong>Methods: </strong>Ten adult Rhesus monkey penises were fixed in 10% buffered formalin and processed for paraffin embedding. Histological sections 5-μm thick were made and stained using histochemical techniques. We assessed the thickness of the tunica albuginea, and in the erectile tissue, the following parameters were analyzed: in the corpus cavernosum (CC): total area, area densities of collagen fibers, muscle fibers and elastic system fibers; in the corpus spongiosum (CS): area densities of collagen fibers, muscle fibers and elastic system fibers. Histomorphometric analyses were carried out on photomicrographs by using ImageJ software.</p><p><strong>Results: </strong>The penis of the Rhesus monkey (Macaca mulatta) has a single CC. The tunica albuginea was thicker in the dorsal region (1.11 ± 0.03 mm) than in the ventral region (0.87 ± 0.01 mm). The quantitative analysis of the CC showed the following values: total area (20.33 ± 5.67 mm²), collagen fibers (24.00 ± 4.00%), muscle fibers (31.52 ± 9.93%) and elastic system fibers (8.46 ± 3.20%). The quantitative analysis of the CS showed the following values: collagen fibers (52.50 ± 11.76%), muscle fibers (10.50 ± 6.36%) and elastic system fibers (15.07 ± 4.78%).</p><p><strong>Conclusion: </strong>The predominance of muscle tissue over connective tissue in the corpus cavernosum, similar to what is observed in humans, qualifies the Rhesus monkey penis as a good experimental model for erectile dysfunction.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telesurgery in Urology is the Hot Topic in this Number of International Brazilian Journal of Urology.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.03.01","DOIUrl":"10.1590/S1677-5538.IBJU.2025.03.01","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Surgical Management of Penile Cancer: Single Port Bilateral Inguinal Lymph Node Dissection.","authors":"Sisto Perdonà, Alessandro Izzo, Antonio Tufano, Francesco Passaro, Giuseppe Quarto, Achille Aveta, Roberto Contieri, Savio Domenico Pandolfo, Riccardo Autorino, Gianluca Spena","doi":"10.1590/S1677-5538.IBJU.2024.0663","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0663","url":null,"abstract":"<p><strong>Introduction: </strong>Penile cancer is a rare but aggressive malignancy, with inguinal lymph node involvement representing a key prognostic indicator (1, 2). NCCN guidelines recommend prophylactic inguinal lymph node dissection (ILND) for intermediate-to-high-risk patients (pT1b, ≥T2) with non-palpable nodes, aiming for early staging and improved outcomes (3). The SP-approach employs a single incision and advanced robotic instrumentation to enhance maneuverability, reduce morbidity, and optimize recovery. Widely used in kidney and prostate surgery (4, 5), this is, to our knowledge, its first application for ILND in Europe.</p><p><strong>Material and methods: </strong>This video shows a novel robotic-assisted bilateral, superficial and deep ILND using the DaVinci SP™ system. In this patient, a preoperative 3D reconstruction allowed detailed visualization of lymph nodes and surrounding structures, enabling precise dissection and an improved intraoperative orientation using Tilepro feature.</p><p><strong>Results: </strong>Compared to open techniques, robotic ILND offers similar lymph node yields with superior cosmetic outcomes and reduced postoperative pain (6). These benefits are amplified with the SP system, which excels in the constrained inguinal region by minimizing instrument interference and enhancing efficiency (7). Fewer incisions minimized risks such as wound infections and skin necrosis (8). Limitations of the SP-technique might include extended operative times, especially during the learning phase, and the absence of long-term oncological data. Additionally, complex cases requiring concurrent pelvic lymphadenectomy may necessitate repositioning the robotic system, increasing procedure time.</p><p><strong>Conclusions: </strong>SP robotic-assisted ILND can represent a significant advancement in the surgical management of penile cancer, combining oncological safety with reduced surgical morbidity. Future studies are needed to validate these findings, compare surgical outcomes, and assess long-term efficacy.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical Cystectomy with Elective Indication to Cutaneous Ureterostomy: Single-Center Comparative Analysis Between Open and Robotic Surgery in Frail Patients.","authors":"Maria Chiara Sighinolfi, Enrico Panio, Tommaso Calcagnile, Simone Assumma, Filippo Gavi, Luca Sarchi, Matti Sagalli, Filippo Turri, Alberto Romano, Alberto Del Nero, Paolo dell'Orto, Marco Sandri, Andrea Gregori, Franco Palmisano, Bernardo Rocco","doi":"10.1590/S1677-5538.IBJU.2024.0556","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0556","url":null,"abstract":"<p><strong>Objectives: </strong>Radical cystectomy (RC) is a surgical procedure associated with high rates of morbidity. The aim of the study is to provide a comparison between robotic (RARC) and open RC (ORC) in patients elected to cutaneous ureterostomy (CUS).</p><p><strong>Materials and methods: </strong>This is a retrospective single-center cohort study performed at a high-volume institution. The study involved 64 patients undergoing RC with CUS, 42 ORC and 22 RARC. The indication for RC was based on EAU guidelines and the choice of CUS was planned due to advanced oncological stage or patient's frailty. Patient allocation to the robotic or open approach for RC was casual, determined by surgeon preference and/or the availability of a robotic operating room. The Adverse events were systematically graded utilizing the Clavien-Dindo classification system.</p><p><strong>Results: </strong>Complications of Clavien Dindo ≥ 2 occurred in 27 out of 42 (64.2%) ORC and 3/22 (13.6%) RARC (p < 0.001); complications of Clavien Dindo ≥ 3 occurred in 10/42 (23.8%) ORC and only 1/22 (4.5%) RARC, respectively (p = 0.08). Multivariable analysis revealed that robotic surgery was the only variable inversely associated with Clavien Dindo ≤ 2 complications.</p><p><strong>Conclusions: </strong>In conclusion, RARC appears to be associated with lower morbidity and reduced incidence of complications, elements that make it particularly suitable for frail patients with an elective indication for CUS.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation and Comparison of Current Scoring Systems in Encrusted Ure-teral Stent Management: a Multicenter Study.","authors":"Mert Hamza Özbilen, Mehmet Çağlar Çakıcı, Erdem Kısa, Taylan Tığlı, Berk Yasin Ekenci, Burak Tüfekçi, Hilmi Sarı, İbrahim Güven Kartal, Ahmet Nihat Karakoyunlu, Gökhan Koç, Asıf Yıldırım, Hakan Erçil","doi":"10.1590/S1677-5538.IBJU.2024.0500","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0500","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the external validation of four existing scoring systems for encrusted ureteral stents (EUS) and their relationship with stent indwelling time, stone-free rates, multiple surgery sessions, multimodal procedures, and prolonged operation times exceeding 120 minutes in total.</p><p><strong>Materials and methods: </strong>The data of 208 patients who underwent surgery for EUS reviewed. All EUSs were evaluated with 4 scoring systems: ESB (encrusted stone burden), FECal (forgotten, encrusted, calcified), KUB (kidney, ureter and bladder), V-GUES (visual grading for ureteral stone burden).</p><p><strong>Results: </strong>As the duration of stent indwelling time prolonged, a significant increase is observed in the scores of ESB, FECal, KUB and V-GUES systems (p<0.001). In multivariate logistic regression analysis, V-GUES score (p=0.025) and stent indwelling time (p=0.014) in stone-free rate, FECal grade (p<0.001) in multimodal procedure requirement, FECal (p=0.002) and V-GUES (p=0.032) scores in multiple surgery sessions, and stent indwelling time (p=0.019) and KUB score (p<0.001) in prolonged operation time were found to be predictors. When the area under receiver operating characterictic (ROC) curves (AUC) of the nomograms were examined, V-GUES score (AUC=0.685) in stone-free rate, FECal grade (AUC=0.780) in multimodal procedure requirement, FECal grade (AUC=0.845) in multiple surgery sessions, and KUB score (AUC=0.860) in prolonged operation time were found to be superior.</p><p><strong>Conclusions: </strong>The management of EUSs is often challenging for urologists. Although the current scoring systems for EUS differ somewhat, it is important to use scoring systems to guide the management of these patients.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment: Epidemiology of Spinal Cord Injury in Adults in Sweden, 2016-2020: ARetrospective Registry-Based Study.","authors":"Nilson Marquardt, Marcio A Averbeck","doi":"10.1590/S1677-5538.IBJU.2025.9909","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9909","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsed TM-YAG laser (Thulio®): a new weapon in endourologists' hand in the conservative management of imperative cases of Upper Tract Urothelial Carcinoma (UTUC).","authors":"Riccardo Scalia, Stefano Gisone, Rebeca Escobar, Silvia Proietti, Franco Gaboardi, Guido Giusti","doi":"10.1590/S1677-5538.IBJU.2024.0653","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0653","url":null,"abstract":"<p><strong>Introduction: </strong>Urothelial carcinomas (UC) represent the sixth most common tumor by incidence, involving the lower or upper urinary tracts (UTUC) (1). High-risk patients should be treated by nephroureterectomy with complete bladder cuff excision (2), conservative approach is reserved for low-risk UTUCs and/or imperative cases (3).</p><p><strong>Materials and methods: </strong>We present a 70-year-old male patient, smoker, with history of urothelial carcinoma. He underwent distal ureterectomy with ileal replacement in April 2019. Since then, he has developed several UTUC recurrences bilaterally and in the bladder, which have been treated conservatively. In August 2023, CT- scan showed multiple recurrences in the left kidney and ureter. Hence, on November 2023, we performed cystoscopy, monopolar resection of bladder tumor and bilateral flexible ureteroscopy (fURS) with pulsed thulium:YAG (p-Tm:YAG) ablation of the tumors. We performed a no-touch technique fURS with Video Uretero-Renoscope FLEX-XC1 by Storz. After this, we placed an ureteral access sheath and then a biopsy by using a tipless basket. The laser fiber used was 272 µm and the laser settings were 0.8 J - 10 Hz - Long pulse Ablation (10 W).</p><p><strong>Results: </strong>The pathological results showed UTUC bilaterally and high-grade UC in the bladder. Then, he underwent intravenous therapy with enfortumab - vedotin and the follow-ups, in February 2024 and June 2024, showed no evidence of recurrences at the multiple biopsies.</p><p><strong>Conclusion: </strong>The p-Tm:YAG laser can be considered a valid alternative option for the conservative treatment of UTUCs. With that said, stringent follow-up remains a mainstay in the conservative treatment of imperative cases of UTUC.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}