Treatment of the pyelocalyceal tumors with laser

Abstract

Transitional cell carcinoma of the upper urinary tract (UUT-TCC) is relatively uncommon, accounting for 2-5% of all urothelial tumors. Its incidence appears to be increasing as a result of progress in imaging, endoscopy, and improved survival from bladder cancer. Renal pelvis tumors represent 10% of all renal cancers. Pyelic neoplasms occur at a rate twice to four times the incidence of tumors in the ureter, where the common site is the distal tract (about 70%). One third of UUT-TCC ore multifocal, and about 1% are simultaneous and bilateral. The introduction of lasers represented a big step in the diagnosis and endoscopic treatment of upper urinary tract tumors. A successful laser treatment is defined by the careful selection of the patients affected by urinary tract lesions. Usually, only patients affected by low grade and papillary lesion should be treated endoscopically with laser. Patients with high grade and invasive lesions should rather be submitted to surgical procedure. Actually, the urologist has a wide choice in laser technology (Holmium laser, Thulium laser). For a correct and safe treatment of ureteral and pyelic lesions with lasers it is mandatory to respect some technical advises. First of all, an adequate access for a good vision of ureter and renal pelvis is imperative. In fact, the urologist should always work in safety, with an optimal control of the instrumentation. Then, it is important to define the laser type and its energy level. The development in laser technology (i.e. small and flexible laser fibers) allows also a radical, safe and minimally invasive treatment of urothelial lesions using flexible ureteroscopes. Of course it is mandatory to evaluate the grade and stage of the tumors by means of the ureteroscopic biopsies: invasive tumors must be treated by immediate nephroureterectomy while the endoscopic treatment should be reserved to those patients with a solitary kidney, renal failure, bilateral tumors, severe comorbities or affected by a solitary tumors with <15 mm in diameter and of low-grade/stage.