Holmium:YAG laser ablation of upper urinary tract transitional cell carcinoma with new Olympus digital flexible ureteroscope
A 62-year-old male with a history of tuberculosis and left nephroureterectomy in 1992 because mastic kidney was admitted to our hospital presenting repeated microscopically haematuria.\nInitially, IVU and CT were performed, without conclusive findings in the collecting system. Due to higher resolution image and diagnostic ability, endoscopy is commonly used to diagnose upper urinary tract tumors by our group in selected cases. Then, using an access sheath 12/14 Flexor TM (Cook) and with the help of a hydrophilic guide wire (Terumo 0.035"), we performed a flexible ureteroscopy, revealing a small papillary tumor in the right kidney middle calyx. A biopsy of the tumor was obtained by 2.4 Fr tipless nitinol basket. The result of the biopsy was a low-grade urothelial tumor. Cytology was negative.\nAfter discussion regarding ureteroscopic treatment of this lesion, including the theoretical risk of tumor recurrences we decided ureteroscopic management of the tumor using Holmium:YAG laser ablation.\nA new 8.5 F Olympus® digital ureteroscope (ODF-URS): URF-V was used to locate the urothelial tumor [] and ablation of the tumor was performed by 200 μm laser Stone Light 15 W Ho: YAG fiber [Figures and ] set at 1.0 J and 10 Hz.\nThe procedure was completed in 30 min, and the estimated blood loss was less than 50 mL. A Foley catheter was placed after surgery up to 12 h.\nPatient hospital stay was 24 h without any post-operative complication. The patient has been followed for 6 months without evidence of recurrence on surveilance ureteroscopy, cytology, cystoscopy or IVU.