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Experts’ recommendations in laser use for the treatment of upper tract urothelial carcinoma: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training Research in Urological Surgery and Technology (T.R.U.S.T.) group

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Abstract

Purpose

To highlight and compare experts’ laser settings during endoscopic laser treatment of upper tract urothelial carcinoma (UTUC), to identify measures to reduce complications, and to propose guidance for endourologists.

Methods

Following a focused literature search to identify relevant questions, a survey was sent to laser experts. We asked participants for typical settings during specific scenarios (ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous treatment). These settings were compared among the reported laser types to find common settings and limits. Additionally, we identified preventive measures commonly applied during surgery.

Results

Twenty experts completed the survey, needing a mean time of 12.7 min. Overall, most common laser type was Holmium–Yttrium–Aluminum–Garnet (Ho:YAG) (70%, 14/20) followed by Thulium fiber laser (TFL) (45%, 9/20), pulsed Thulium–Yttrium–Aluminum–Garnet (Tm:YAG) (3/20, 15%), and continuous wave (cw)Tm:YAG (1/20, 5%). Pulse energy for the treatment of distal ureteral tumors was significantly different with median settings of 0.9 J, 1 J and 0.45 J for Ho:YAG, TFL and pulsed Tm:YAG, respectively (p = 0.048). During URS and RIRS, pulse shapes were significantly different, with Ho:YAG being used in long pulse and TFL in short pulse mode (all p < 0.05). We did not find further disparities.

Conclusion

Ho:YAG is used by most experts, while TFL is the most promising alternative. Laser settings largely do not vary significantly. However, further research with novel lasers is necessary to define the optimal approach. With the recent introduction of small caliber and more flexible scopes, minimal-invasive UTUC treatment is further undergoing an extension of applicability in appropriately selected patients.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

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Funding

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Author information

Authors and Affiliations

  1. Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria

    Gernot Ortner, Gerhard Kitzbichler & Udo Nagele

  2. Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria

    Gernot Ortner, Thomas R. W. Herrmann, Udo Nagele & Theodoros Tokas

  3. Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England

    Bhaskar Kumar Somani & Amelia Pietropaolo

  4. Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey

    Selcuk Güven

  5. Sorbonne University, GRC n°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France

    Olivier Traxer

  6. Department of Urology, San Raffaele Hospital, Milan, Italy

    Guido Giusti & Silvia Proietti

  7. Department of Urology, University of Patras, Patras, Greece

    Evangelos Liatsikos & Panagiotis Kallidonis

  8. Department of Urology, Haukeland University Hospital, Bergen, Norway

    Øyvind Ulvik

  9. Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy

    Ioannis Kartalas Goumas

  10. Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel

    Mordechai Duvdevani

  11. Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Joyce Baard & Guido M. Kamphuis

  12. Department of Urology, Hospital and University of Modena, Modena, Italy

    Stefania Ferretti

  13. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Laurian Dragos

  14. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy

    Luca Villa

  15. Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany

    Arkadiusz Miernik

  16. Department of Urology, University Hospital Ghent, Ghent, Belgium

    Thomas Tailly

  17. Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia

    Saeed Bin Hamri

  18. 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Athanasios Papatsoris

  19. Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany

    Ali Serdar Gözen

  20. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  21. Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece

    Theodoros Tokas

Authors
  1. Gernot Ortner
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  2. Bhaskar Kumar Somani
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  3. Selcuk Güven
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  26. Theodoros Tokas
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Contributions

GO and TT had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TT. Acquisition of data: GO, TT, BKS, SG, GK, OT, GG, SP, EL, PK, ØU, IKG, MD, JB, GMK, SF, LD, LV, AM, TT, AP, SBH, AP, ASG, TH, UN. Analysis and interpretation: GO, TT. Drafting of the manuscript: GO, TT. Critical revision of the manuscript: TT, BKS, SG, TH, UN, ASG. Statistical analysis: GO. Obtaining funding: None. Administrative, technical, or material support: GO, TT, UN, TH. Supervision: TT.

Corresponding author

Correspondence to Gernot Ortner.

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Conflict of interest

Gernot Ortner certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Thomas Tailly: Consultant Boston Scientific, Cook Medical, Dornier, Storz. Guido Kamphuis: Advisory board: Boston Scientific, Olympus, Honoraria: Alnylam, Boston Scientific, Coloplast Porgès, Olympus. Amelia Pietropaolo: Consultant Boston Scientific, Ambu, Pusen. Panagiotis Kallidonis: Consultant Cook Medical, EMS. Mordechai Duvdevani: Consultant Boston Scientific. Udo Nagele: Consultant Baxter, Boston Scientific, Optimed, Storz medical, B + K. Laurian Dragos: Consultant EMS, Boston Scientific, Ambu. Silvia Proietti: Consultant Boston Scientific. Joyce Baard: Consultant Coloplast, Boston Scientific, Olympus, Urogen. Øyvind Ulvik: Lectures Olympus.

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This review does not involve human participants and/or animals.

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No patients were included in the study.

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Ortner, G., Somani, B.K., Güven, S. et al. Experts’ recommendations in laser use for the treatment of upper tract urothelial carcinoma: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training Research in Urological Surgery and Technology (T.R.U.S.T.) group. World J Urol 41, 3367–3376 (2023). https://doi.org/10.1007/s00345-023-04632-4

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