title: Long-term results and management of ureteral transitional cell carcinoma using the holmium: YAG laser via rigid-ureteroscopy.
abstract: The standard operative procedure for ureteral transitional cell carcinoma is nephrouterectomy with partial cystectomy at the affected ureteral orifice. However, nephron-sparing surgery and endoscopic surgery and management have become common practice for low-grade and low-stage cases. We investigated the follow-up results of patients who underwent endoscopic surgery using the holmium:YAG laser, and evaluated its treatment effect. The patients were 4 men and 3 women aged from 68 to 87 years (mean: 74.7 years). Two were imperative cases and 5 were elective cases. The tumor size ranged from 8 to 25 mm (mean: 15.4 mm). Hydronephrosis was not found in any case, and urinary cytology was negative in all cases. Biopsy revealed 5 cases of grade 1, and 2 of grade 2. A Versa Pulse Select 80 laser generator, a 365-microm slim line laser fiber, and a rigid ureteroscope with 8F-point diameter were used. A 6F double J catheter was placed postoperatively for 3 weeks. Pulse energy was set at 0.5-1.0 J (mean: 0.8 J) with a frequency of 10 Hz. The total amount of energy was 0.9-11.22 KJ (mean: 2.89 KJ) and the operation time including ureteral stent placement was 20-97 min (mean: 66 min). Neither urinary tract perforation nor ureteral stricture associated with laser irradiation was observed. The postoperative follow-up period ranged from 23-88 months (mean: 67.8 months). Patients underwent urinary cytological examination once a month, and cystoscopy, retrograde pyelography and urethroscopy once every 3 months for 2 years, then once every 6 months thereafter. One patient developed tumor recurrence 23 months after surgery and received another laser treatment, but no recurrence has been observed in the other 6 patients (85.7%). Transurethral endoscopic surgery and management using the holmium:YAG laser is safe and effective nephron-sparing surgery for ureteral transitional cell carcinoma, and good long-term treatment results can be expected even in elective cases if the indications are carefully selected.
authors.affiliation: Department of Urology, Aichi Medical University School of Medicine, Aichi 480-1195, Japan. yy1124@aichi-med-u.ac.jp
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamada
authors.forename: Yasusuke
authors.initials: Y
authors.lastname: Inoue
authors.forename: Kogenta
authors.initials: K
authors.lastname: Nakamura
authors.forename: Katsuya
authors.initials: K
authors.lastname: Naruse
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Aoki
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Taki
authors.forename: Motoi
authors.initials: M
authors.lastname: Tobiume
authors.forename: Kenji
authors.initials: K
authors.lastname: Zennami
authors.forename: Remi
authors.initials: R
authors.lastname: Katsuda
authors.forename: Kouji
authors.initials: K
authors.lastname: Hara
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kato
authors.forename: Masahito
authors.initials: M
authors.lastname: Watanabe
authors.forename: Keiko
authors.initials: K
authors.lastname: Hayashida
authors.forename: Yumi
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kato
authors.forename: Reiko
authors.initials: R
authors.lastname: Ajisaka
authors.forename: Inbou
authors.initials: I
authors.lastname: Kyoku
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noguchi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Honda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D014516:Ureteral Neoplasms / Q000601:surgery*; D018666:Ureteroscopy