Effectiveness and Safety of Thulium Fiber Laser in the Conservative Management of Patients with Upper Tract Urothelial Carcinoma

Thulium fiber laser (TFL) is a safe and effective laser technique for conservative treatment of upper urinary tract carcinoma (UTUC). Effective tumor ablation and hemostasis were achieved without any major complications. Prospective randomized studies in larger populations with longer-term follow-up using different laser sources are required to confirm the effectiveness and safety of TFL in conservative UTUC treatment. Few clinical data are available on thulium fiber laser (TFL) and conservative treatment of upper urinary tract urothelial carcinoma (UTUC). To assess the effectiveness and safety of TFL in the conservative treatment of UTUC in terms of both tumor ablation and complication rates in a short-term follow-up. Retrospective data were collected from all patients who underwent endoscopic management of UTUC between January 2021 and April 2022. All patients with nonmetastatic UTUC who were deemed suitable candidates (low- and high-grade disease) for conservative treatment were reviewed. All patients underwent ureteroscopy with biopsy and at 2, 6, and 12 mo after the first surgery. UTUC ablation was achieved using TFL. Clinical data were collected in a dedicated database. Intra- and postoperative outcomes were assessed. A descriptive statistical analysis was performed. In total, 28 patients were evaluated. Thirteen patients (46.4%) were included in the low-risk UTUC treatment group and 15 (53.6%) in the high-risk group. The mean tumor size was 15.3 ± 5.7 mm. Biopsy showed low- and high-grade UTUCs in 19 and eight patients, respectively. Only one biopsy was inconclusive for achieving a diagnosis. At the second procedure biopsy, no tumor was found in 19 cases (70.4%), whereas seven had tumors confirmed (25.9%). To date, 23 and 17 out of 26 patients completed the 6- and 12-mo follow-up, respectively. UTUC recurrence was detected in five of 23 patients (21.7%) and in three of 17 patients (17.7%) at 6 and 12 mo, respectively. A total of 95 procedures were performed. No intraoperative complications were observed. In ten of the 95 procedures (10.5%), Clavien-Dindo grade I–II postoperative complications were experienced. Only one grade IIIB postoperative complication was noted. TFL is a safe and effective technique for conservative treatment of UTUC in a short-term follow-up. Optimal tumor ablation and fine hemostatic control were achieved without major complications. In this study, we looked at the outcomes of upper urinary tract tumors conservatively treated