title: Clinical experience of ureteroscopic treatment for ureteral transitional cell carcinoma using the Holmium:YAG laser.
abstract: The standard operative method for ureteral transitional cell carcinoma is nephrouterectomy with partial bladder excision of the ureteral orifice of the affected bladder. However, a conservative kidney operation and endoscopy are now being performed for low grade, low stage cases. We performed an operation using a Holmium: YAG laser, and examined its safety and efficacy. The patients were four men, and 1 woman aged from 68 to 87 (mean 78) years. There were 2 imperative cases (1 solitary kidney case, and 1 high-risk case), and 3 elective cases. The tumor size ranged from 8 to 25 (mean 14) mm. Urinary cytology was negative in all cases, and the tumors were pathologically diagnosed as grade 1 atypism on biopsy. A VersaPulse Select 80 laser generator, a 365 micro m SlimLine laser fiber, and an 8F rigid ureteroscope were used. A 6F double J catheter was indwelt for three weeks after the surgery. The pulse energy setting was 0.5-1.0 J, and the frequency was 10 Hz. The total amount of energy was 1.02-11.22 (mean 3.56) kJ, and the operation time was 20-97 (mean 50) min including the time for indwelling a ureteral stent. Neither urinary tract perforation nor ureteral stricture caused by the laser irradiation were observed. The patients have been followed by examining urine cytology once a month, and cystoscopy, retrograde pyelography, and urethroscopy once every 3 months. No recurrence has been observed as of 4-20 (mean 10) months postoperatively. Transurethral endoscopic resection using a Holmium: YAG laser is a safe and effective therapy for ureteral transitional cell carcinoma while preserving kidney and a good treatment outcome can be expected even in elective cases.
authors.affiliation: Department of Urology, Aichi Medical University, School of Medicine, Aichi 480-1195, Japan. 101959@gk.amu.aichi-med-u.ac.jp
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamada
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Honda
authors.forename: Kogenta
authors.initials: K
authors.lastname: Nakamura
authors.forename: Hatsuki
authors.initials: H
authors.lastname: Hibi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nanaura
authors.forename: Eiji
authors.initials: E
authors.lastname: Nishikawa
authors.forename: Ayumi
authors.initials: A
authors.lastname: Kamijou
authors.forename: Kenji
authors.initials: K
authors.lastname: Mitsui
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Taki
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Aoki
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kokubo
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Fukatsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D011859:Radiography; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy