脉冲TM-YAG激光(Thulio®):泌尿科医师保守治疗上尿路上皮癌(UTUC)的新武器。

IF 4.5 3区 医学 Q1 UROLOGY & NEPHROLOGY
Riccardo Scalia, Stefano Gisone, Rebeca Escobar, Silvia Proietti, Franco Gaboardi, Guido Giusti
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引用次数: 0

摘要

导言:尿路上皮癌(UC)是发病率第六高的肿瘤,涉及下尿路或上尿路(UTUC)(1)。高危患者应采用肾输尿管切除术并完全切除膀胱袖(2),保守方法适用于低风险的UTUCs和/或紧急病例(3)。材料和方法:我们报告了一位70岁男性患者,吸烟者,有尿路上皮癌病史。2019年4月,他接受了远端输尿管切除术和回肠置换术。从那时起,他出现了几次双侧和膀胱的UTUC复发,并接受了保守治疗。2023年8月CT示左肾及输尿管多发复发。因此,我们于2023年11月行膀胱镜检查、单极膀胱肿瘤切除术和双侧输尿管镜检查(fURS),并对肿瘤进行脉冲铥:YAG (p-Tm:YAG)消融。我们采用Storz公司FLEX-XC1型输尿管镜进行无接触技术fURS。在此之后,我们放置了输尿管鞘,然后用无头筐进行了活检。使用的激光光纤为272µm,激光设置为0.8 J ~ 10 Hz -长脉冲消融(10 W)。结果:病理结果显示双侧UTUC和膀胱高度UC。然后,他接受了静脉注射注射,并于2024年2月和2024年6月进行了随访,在多次活检中没有发现复发的证据。结论:p-Tm:YAG激光可作为UTUCs保守治疗的有效选择。话虽如此,严格的随访仍然是保守治疗重症UTUC病例的支柱。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pulsed TM-YAG laser (Thulio®): a new weapon in endourologists' hand in the conservative management of imperative cases of Upper Tract Urothelial Carcinoma (UTUC).

Introduction: 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).

Materials and methods: 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).

Results: 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.

Conclusion: 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.

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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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