Upper tract urothelial carcinoma (UTUC) is a relatively rare disease with an aggressive phenotype compared to urothelial carcinoma in the bladder. In recent years, kidney-sparing surgery (KSS) and, in particular, endoscopic surgery have become the procedure of choice among urologists where the treatment of localized UTUC is concerned. Endoscopy tends to result in satisfactory oncological disease control while lowering morbidity and minimizing complications amongst the appropriately selected cohort of patients. While endoscopic surgery for UTUC might appear to be standardized, it, in fact, differs considerably depending on the source of energy used for resection/ablation. There has been little reliable data up to now on which laser energy source is the most superior. The goal of this review is, therefore, to outline the results of endoscopic UTUC treatment using different lasers and to analyze how these laser-tissue interactions may affect the surgery. We start by pointing out that the data remains insufficient when trying to determine which laser is the most effective in the endoscopic management of UTUC. The ever-growing number of indications for minimally invasive treatment and the increasing number of centers using laser surgery will, hopefully, lead to novel randomized controlled trials that compare the performance characteristics of the lasers as well as the effects of UTUC on patients.

Department of Oncology Johns Hopkins University School of Medicine Baltimore MD 21287 USA

Department of Urology 2nd Faculty of Medicine Charles University 150 06 Prague Czech Republic

Department of Urology James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore MD 21287 USA

Department of Urology Medical University of Vienna 1030 Vienna Austria

Department of Urology University of Texas Southwestern Dallas TX 75390 USA

Department of Urology Weill Cornell Medical College New York NY 10065 USA

Division of Urology Department of Special Surgery Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman 19328 Jordan

Division of Urology Rabin Medical Center Petach Tikva 4920232 Israel

Institute for Clinical Medicine Sechenov University 119021 Moscow Russia

Institute for Urology and Reproductive Health Sechenov University 119435 Moscow Russia

Karl Landsteiner Institute of Urology and Andrology 3100 Vienna Austria

Sackler Faculty of Medicine Tel Aviv University Tel Aviv 6997801 Israel

Zobrazit více v PubMed

Witjes J., Burger M. Muscle-Invasive and Metastatic Bladder Cancer EAU Guidelines on 2022. EAU Central Office; Arnhem, The Netherlands: 2022.

Rouprêt M., Babjuk M. Upper Urinary Tract Urothelial Carcinoma EAU Guidelines on 2022. EAU Central Office; Arnhem, The Netherlands: 2022.

Seisen T., Peyronnet B., Dominguez-Escrig J.L., Bruins H.M., Yuan C.Y., Babjuk M., Böhle A., Burger M., Compérat E., Cowan N., et al. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel. Eur. Urol. 2016;70:1052–1068. doi: 10.1016/j.eururo.2016.07.014. PubMed DOI

Cutress M.L., Stewart G.D., Zakikhani P., Phipps S., Thomas B.G., Tolley D.A. Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): Systematic review. BJU Int. 2012;110:614–628. doi: 10.1111/j.1464-410X.2012.11068.x. PubMed DOI

Scotland K.B., Hubbard L., Cason D., Banks J., Leong J.Y., Healy K., Leiby B., Hubosky S., Bagley D. Long term outcomes of ureteroscopic management of upper tract urothelial carcinoma. Urol. Oncol. Semin. Orig. Investig. 2020;38:850.e17–850.e26. doi: 10.1016/j.urolonc.2020.06.027. PubMed DOI

Traxer O., Corrales M. Conservative Treatment for Upper Urinary Tract Urothelial Carcinoma. Eur. Urol. Open Sci. 2021;32:38. doi: 10.1016/j.euros.2021.08.001. PubMed DOI PMC

Defidio L., Antonucci M., De Dominicis M., Fuchs G., Patel A. Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center. J. Endourol. 2019;33:902–908. doi: 10.1089/end.2019.0308. PubMed DOI

Shvero A., Abu-Ghanem Y., Laufer M., Dotan Z.A., Zilberman D.E., Mor Y., Portnoy O., Fridmen E., Winkler H., Kleinmann N. Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma. J. Urol. 2021;205:1039–1046. doi: 10.1097/JU.0000000000001505. PubMed DOI

Villa L., Haddad M., Capitanio U., Somani B.K., Cloutier J., Doizi S., Salonia A., Briganti A., Montorsi F., Traxer O. Which Patients with Upper Tract Urothelial Carcinoma Can be Safely Treated with Flexible Ureteroscopy with Holmium:YAG Laser Photoablation? Long-Term Results from a High Volume Institution. J. Urol. 2018;199:66–73. doi: 10.1016/j.juro.2017.07.088. PubMed DOI

Gurbuz C., Youssef R.F., Shariat S.F., Lotan Y., Wood C.G., Sagalowsky A.I., Zigeuner R., Kikuchi E., Weizer A., Raman J.D., et al. The impact of previous ureteroscopic tumor ablation on oncologic outcomes after radical nephrouretectomy for upper urinary tract urothelial carcinoma. J. Endourol. 2011;25:775–779. doi: 10.1089/end.2010.0396. PubMed DOI

Territo A., Foerster B., Shariat S.F., Rouprêt M., Gaya J.M., Palou J., Breda A. Diagnosis and kidney-sparing treatments for upper tract urothelial carcinoma: State of the art. Minerva Urol. Nefrol. 2018;70:242–251. doi: 10.23736/S0393-2249.18.03058-8. PubMed DOI

Hermann T.R., Liatsikos E., Nagele U., Traxer O., Merseburger A.S. Guidelines on Lasers and Technologies. Urology. 2014;5847:783–795. doi: 10.1016/j.eururo.2012.01.010. PubMed DOI

Janda P., Sroka R., Mundweil B., Betz C.S., Baumgartner R., Leunig A. Comparison of thermal tissue effects induced by contact application of fiber guided laser systems. Lasers Surg. Med. 2003;33:93–101. doi: 10.1002/lsm.10199. PubMed DOI

Shvero A., Zilberman D.E., Dotan Z.A., Laufer M., Fridman E., Winkler H., Kleinmann N. Endoscopic management of upper tract urothelial carcinoma—Tips and tricks. Transl. Androl. Urol. 2020;9:1815820. doi: 10.21037/tau.2020.01.07. PubMed DOI PMC

Emiliani E., Herrmann T.R.W., Breda A. Thulium laser for the treatment of upper urinary tract carcinoma (UTUC)? Are we there, yet? World J. Urol. 2015;33:595–597. doi: 10.1007/s00345-015-1511-x. PubMed DOI

Niţă G., Georgescu D., Mulţescu R., Draguţescu M., Mihai B., Geavlete B., Persu C., Geavlete P. Prognostic factors in laser treatment of upper urinary tract urothelial tumours. J. Med. Life. 2012;5:33–38. PubMed PMC

Grossman H.B., Schwartz S.L., Konnak J.W., Segura J.W. Ureteroscopic treatment of urothelial carcinoma of the ureter and renal pelvis. J. Urol. 1992;148:275–277. doi: 10.1016/S0022-5347(17)36570-9. PubMed DOI

Orihuela E., Smith A.D. Percutaneous treatment of transitional cell carcinoma of the upper urinary tract. Urol. Clin. N. Am. 1988;15:425–431. doi: 10.1016/S0094-0143(21)01586-X. PubMed DOI

Kaufman R.P., Carson C.C. Ureteroscopic management of transitional cell carcinoma of the ureter using the neodymium: YAG laser. Lasers Surg. Med. 1993;13:625–628. doi: 10.1002/lsm.1900130606. PubMed DOI

Malloy T.R., Schultz R.E., Wein A.J., Carpiniello V.L. Renal preservation utilizing neodymium: YAG laser. Urology. 1986;27:99–103. doi: 10.1016/0090-4295(86)90363-8. PubMed DOI

Elliott D.S., Blute M.L., Patterson D.E., Bergstralh E.J., Segura J.W. Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma. Urology. 1996;47:819–825. doi: 10.1016/S0090-4295(96)00043-X. PubMed DOI

Elliott D.S., Segura J.W., Lightner D., Patterson D.E., Blute M.L. Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney. Urology. 2001;58:174–178. doi: 10.1016/S0090-4295(01)01109-8. PubMed DOI

Enikeev D., Shariat S.F., Taratkin M., Glybochko P. The changing role of lasers in urologic surgery. Curr. Opin. Urol. 2020;30:24–29. doi: 10.1097/MOU.0000000000000695. PubMed DOI

Taratkin M., Kovalenko A., Laukhtina E., Paramonova N., Spivak L., Wachtendorf L.J.J., Eminovic S., Afyouni A.S., Okhunov Z., Karagezyan M., et al. Ex vivo study of Ho: YAG and thulium fiber lasers for soft tissue surgery: Which laser for which case? Lasers Med Sci. 2020;37:149–154. doi: 10.1007/s10103-020-03189-7. PubMed DOI

Taratkin M., Azilgareeva C., Taratkina D., Goryacheva E., Rapoport L., Enikeev D. Laser endoscopic procedures on the prostate: It is the small details that count. Curr. Opin. Urol. 2021;31:468–472. doi: 10.1097/MOU.0000000000000919. PubMed DOI

Cornu J.N., Rouprêt M., Carpentier X., Geavlete B., de Medina S.G.D., Cussenot O., Traxer O. Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma. World J. Urol. 2010;28:151–156. doi: 10.1007/s00345-009-0494-x. PubMed DOI

Hoffman A., Yossepowitch O., Erlich Y., Holland R., Lifshitz D. Oncologic results of Nephron sparing endoscopic approach for upper tract low grade transitional cell carcinoma in comparison to nephroureterectomy—A case control study. BMC Urol. 2014;14:97. doi: 10.1186/1471-2490-14-97. PubMed DOI PMC

Painter D.J., Denton K., Timoney A.G., Keeley F.X. Ureteroscopic management of upper-tract urothelial cancer: An exciting nephron-sparing option or an unacceptable risk? J. Endourol. 2008;22:1237–1239. doi: 10.1089/end.2008.0187. PubMed DOI

Yamane H., Honda M., Shimizu R., Teraoka S., Kimura Y., Yumioka T., Iwamoto H., Morizane S., Hikita K., Takenaka A. Endoscopic Ablation of Upper Tract Urothelial Carcinoma: A Report of Two Cases with Long Disease Recurrence-Free Periods. Yonago Acta Med. 2022;65:171–175. doi: 10.33160/yam.2022.05.005. PubMed DOI PMC

Matsuoka K., Iida S., Tomiyasu K., Inoue M., Noda S. Transurethral endoscopic treatment of upper urinary tract tumors using a holmium: YAG laser. Lasers Surg. Med. 2003;32:336–340. doi: 10.1002/lsm.10184. PubMed DOI

Aboumarzouk O.M., Somani B., Ahmad S., Nabi G., Townell N., Kata S. Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma. Urol. Ann. 2013;5:184–189. doi: 10.4103/0974-7796.115746. PubMed DOI PMC

Proietti S., Rodríguez-Socarrás M.E., Eisner B.H., Lucianò R., Basulto Martinez M.J., Yeow Y., Rapallo I., Saitta G., Scarfò F., Gaboardi F., et al. Thulium:YAG Versus Holmium:YAG Laser Effect on Upper Urinary Tract Soft Tissue: Evidence from an Ex Vivo Experimental Study. J. Endourol. 2021;35:544–551. doi: 10.1089/end.2020.0222. PubMed DOI

Defidio L., De Dominicis M., Di Gianfrancesco L., Fuchs G., Patel A. First collaborative experience with thulium laser ablation of localized upper urinary tract urothelial tumors using retrograde intra-renal surgery. Arch. Ital. Urol. Androl. 2011;83:147–153. PubMed

Musi G., Mistretta F.A., Marenghi C., Russo A., Catellani M., Nazzani S., Conti A., Luzzago S., Ferro M., Matei D.V., et al. Thulium Laser Treatment of Upper Urinary Tract Carcinoma: A Multi-Institutional Analysis of Surgical and Oncological Outcomes. J. Endourol. 2018;32:257–263. doi: 10.1089/end.2017.0915. PubMed DOI

Wen J., Ji Z.G., Li H.Z. Treatment of upper tract urothelial carcinoma with ureteroscopy and thulium laser: A retrospective single center study. BMC Cancer. 2018;18:196. doi: 10.1186/s12885-018-4118-y. PubMed DOI PMC

Bozzini G., Gastaldi C., Besana U., Calori A., Casellato S., Parma P., Pastore A., Macchi A., Breda A., Gozen A., et al. Thulium-laser retrograde intra renal ablation of upper urinary tract transitional cell carcinoma: An ESUT Study. Minerva Urol. Nephrol. 2021;73:114–121. doi: 10.23736/S2724-6051.20.03689-9. PubMed DOI

Heinrich E., Wendt-Nordahl G., Honeck P., Alken P., Knoll T., Michel M.S., Häcker A. 120 W lithium triborate laser for photoselective vaporization of the prostate: Comparison with 80 W potassium-titanyl-phosphate laser in an ex-vivo model. J. Endourol. 2010;24:75–79. doi: 10.1089/end.2009.0051. PubMed DOI

Dursun F., Pan M.M., Morgan M., Gonzalez R.R., Satkunasivam R. 532 nm green-light laser vaporization of upper tract urothelial carcinoma. BMC Urol. 2020;20:172. doi: 10.1186/s12894-020-00744-w. PubMed DOI PMC

Wezel F., Wendt-Nordahl G., Huck N., Bach T., Weiss C., Michel M.S., Häcker A. New alternatives for laser vaporization of the prostate: Experimental evaluation of a 980-, 1318- and 1,70-nm diode laser device. World J. Urol. 2010;28:181–186. doi: 10.1007/s00345-009-0499-5. PubMed DOI

Seitz M., Bayer T., Ruszat R., Tilki D., Bachmann A., Gratzke C., Schlenker B., Stief C., Sroka R., Reich O. Preliminary evaluation of a novel side-fire diode laser emitting light at 940 nm, for the potential treatment of benign prostatic hyperplasia: Ex-vivo and in-vivo investigations. BJU Int. 2009;103:770–775. doi: 10.1111/j.1464-410X.2008.08066.x. PubMed DOI

Herrmann T.R.W., Liatsikos E.N., Nagele U., Traxer O., Merseburger A.S. EAU guidelines on laser technologies. Eur. Urol. 2012;61:783–795. doi: 10.1016/j.eururo.2012.01.010. PubMed DOI

Shoen E., Zollinger B., Gresham T., Rezaei K.M., Whalen M. Use of the T-1470 LiteTouchTM Laser in the En Bloc Resection of an Upper Tract Urothelial Cancer. Case Rep. Urol. 2021;2021:6623326. doi: 10.1155/2021/6623326. PubMed DOI PMC

Enikeev D., Traxer O., Taratkin M., Okhunov Z., Shariat S. A review of thulium-fiber laser in stone lithotripsy and soft tissue surgery. Curr. Opin. Urol. 2020;30:853–860. doi: 10.1097/MOU.0000000000000815. PubMed DOI

Rice P., Somani B.K. A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology. Res. Rep. Urol. 2021;13:519–527. doi: 10.2147/RRU.S233979. PubMed DOI PMC

Yoshida T., Murota T., Matsuzaki T., Nakao K., Ohe C., Matsuda T., Kinoshita H. Photodynamic Diagnosis-guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes. Eur. Urol. Open Sci. 2021;28:17–25. doi: 10.1016/j.euros.2021.03.009. PubMed DOI PMC

Miyake M., Yoshida T., Nishimura N., Oda Y., Shimizu T., Nakahama T., Hori S., Morizawa Y., Gotoh D., Nakai Y., et al. A prospective, single-arm trial of fluorescent ureteroscopy-assisted thulium-holmium: YAG dual laser ablation for upper urinary tract cancer: Study protocol of the FLUAM trial. Contemp. Clin. Trials Commun. 2022;26:100902. doi: 10.1016/j.conctc.2022.100902. PubMed DOI PMC

Shvero A., Zilberman D.E., Laufer M., Dotan Z.A., Ramon J., Winkler H.Z., Kleinmann N. The Efficacy of Endoscopic Dual Laser Treatment for Low Grade Upper Tract Urothelial Carcinoma. Harefuah. 2020;159:170–174. PubMed

Hubosky S.G., Boman B.M., Charles S., Bibbo M., Bagley D.H. Ureteroscopic management of upper tract urothelial carcinoma (UTUC) in patients with Lynch Syndrome (hereditary nonpolyposis colorectal cancer syndrome) BJU Int. 2013;112:813–819. doi: 10.1111/bju.12008. PubMed DOI

Scotland K.B., Kleinmann N., Cason D., Hubbard L., Tanimoto R., Healy K.A., Hubosky S.G., Bagley D.H. Ureteroscopic Management of Large ≥2 cm Upper Tract Urothelial Carcinoma: A Comprehensive 23-Year Experience. Urology. 2018;121:66–73. doi: 10.1016/j.urology.2018.05.042. PubMed DOI

Mugiya S., Ozono S., Nagata M., Otsuka A., Takayama T., Nagae H. Retrograde endoscopic laser therapy and ureteroscopic surveillance for transitional cell carcinoma of the upper urinary tract. Int. J. Urol. 2006;13:1–6. doi: 10.1111/j.1442-2042.2006.01223.x. PubMed DOI

Mugiya S., Maruyama S., Nagata M., Hadano S., Nagae H. Retrograde endoscopic laser therapy for transitional cell carcinoma of the upper urinary tract. Int. J. Urol. 2003;10:371–376. doi: 10.1046/j.1442-2042.2003.00646.x. PubMed DOI

Keeley F.X., Bibbo M., Bagley D.H. Original Articles Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J. Urol. 1997;157:1560–1565. doi: 10.1016/S0022-5347(01)64793-1. PubMed DOI

Boorjian S., Ng C., Munver R., Palese M.A., Sosa R.E., Vaughan E.D., Del Pizzo J.J., Scherr D.S. Abnormal selective cytology results predict recurrence of upper-tract transitional-cell carcinoma treated with ureteroscopic laser ablation. J. Endourol. 2004;18:912–916. doi: 10.1089/end.2004.18.912. PubMed DOI

Boorjian S., Ng C., Munver R., Palese M.A., Vaughan E.D., Sosa R.E., Del Pizzo J.J., Scherr D.S. Impact of delay to nephroureterectomy for patients undergoing ureteroscopic biopsy and laser tumor ablation of upper tract transitional cell carcinoma. Urology. 2005;66:283–287. doi: 10.1016/j.urology.2005.02.022. PubMed DOI

Gadzinski A.J., Roberts W.W., Faerber G.J., Wolf J.S. Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J. Urol. 2010;183:2148–2153. doi: 10.1016/j.juro.2010.02.005. PubMed DOI

Grasso M., Fishman A.I., Cohen J., Alexander B. Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: A 15-year comprehensive review of 160 consecutive patients. BJU Int. 2012;110:1618–1626. doi: 10.1111/j.1464-410X.2012.11066.x. PubMed DOI

Cutress M.L., Stewart G.D., Wells-Cole S., Phipps S., Thomas B.G., Tolley D.A. Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJU Int. 2012;110:1608–1617. doi: 10.1111/j.1464-410X.2012.11169.x. PubMed DOI

Wang G., Zhao D., Spring D.J., DePinho R.A. Genetics and biology of prostate cancer. Genes Dev. 2018;32:1105–1140. doi: 10.1101/gad.315739.118. PubMed DOI PMC

Laukhtina E., Kawada T., Quhal F., Yanagisawa T., Rajwa P., von Deimling M., Pallauf M., Bianchi A., Majdoub M., Enikeev D., et al. Oncologic and Safety Outcomes for Retrograde and Antegrade Endoscopic Surgeries for Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis. Eur. Urol. Focus. 2022 doi: 10.1016/j.euf.2022.11.014. PubMed DOI

Svatek R.S., Shariat S.F., Novara G., Skinner E.C., Fradet Y., Bastian P.J., Kamat A.M., Kassouf W., Karakiewicz P.I., Fritsche H.M., et al. Discrepancy between clinical and pathological stage: External validation of the impact on prognosis in an international radical cystectomy cohort. BJU Int. 2011;107:898–904. doi: 10.1111/j.1464-410X.2010.09628.x. PubMed DOI

Favaretto R.L., Shariat S.F., Savage C., Godoy G., Chade D.C., Kaag M., Bochner B.H., Coleman J., Dalbagni G. Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle-invasive and non-organ confined disease in patients with upper tract urothelial carcinoma. BJU Int. 2012;109:77–82. doi: 10.1111/j.1464-410X.2011.10288.x. PubMed DOI PMC