使用銩雷射搭配硬式輸尿管鏡來治療輸尿管泌尿道上皮癌:台北馬偕紀念醫院經驗
林鼎博、林文榮、林文州、張奐光、楊志東、許炯明、周永強、蔡維恭、江百凱、陳建志、李致樵、邱文祥
馬偕紀念醫院 泌尿科
Semi-rigid Ureteroscopy with Thullium Laser for the Treatment of Ureter Urothelial Carcinoma: Experience of Mackay Memorial Hospital.
Ting-Po Lin
Department of Urology, Mackay Memorial Hospital, Taipei
Purpose:
Radical nephroureterectomy is the standard treatment of high risk upper tract urothelial carcinoma (UTUC). However, renal-sparing treatment as endoscopic ablation or segmental resection can be used for low risk ureter urothelial carcinoma without compromising oncological outcomes. In present study, we share the experience of using semi-rigid uretersoscope with Thullium laser to treat ureter urothelial carcinoma.
Materials and Methods:
We retrospectively reviewed 9 cases with ureter urothelial carcinoma managed by Thullium laser with semi-rigid uretersoscope from January 2014 to June 2015 in our hospital. Peri-operative outcome and post-operative outcome were recorded.
Results:
There are 9 patients underwent endoscopic treatment. Mean (range) age was 67.1 (56~85) years old. Mean (range) follow up was 13.9 (3~22) months. Overall survival rate was 100%. Five patients received endoscopic management due to low-risk tumor. Upper tract progression or persisted carcinoma in situ was noted in three patients (60%), all of them received nephroureterectomy after then. Four patients received endoscopic treatment because they are not suitable to nephroureterectomy. All of the four patients with high risk or not suitable to nephroureterectomy had recurrence. No major complication was noted perioperatively.
Conclusion:
After endoscopic surgery, upper tract recurrence is common even in low risk tumor. Regular surveillance with URS is needed. Salvage nephroureterectomy is advised during close follow up.