Endoscopic Treatment of UTUC

Technique Description:

• Flexible ureteroscopy with single-use digital scope (LithoVue)
• Attempt at retrograde ablation by Thulium and Holmium lasers
• Possible conversion to supine percutaneous resection

Procedure Steps:

• 1. Lithotomy position with slight elevation of right flank; scrubbing and draping for ECIRS
• 2. Removal of stent left 3 weeks ago during the diagnostic ureteroscopy and biopsy
• 3. Insertion of 2 guide wires (Sensor for safety and Zebra for insertion of ureteral access sheath UAS)
• 4. Insertion of UAS (11/13 Navigator)
• 5. Ureteroscopy, assessment of tumor location and size and attempt of laser ablation
• 6. Due to the tumor size, possible conversion to percutaneous resection in supine position: retrograde pyelography, renal puncture, dilation and percutaneous resection
• 7. Internal stenting (Percuflex 7/26)
• 8. If uneventful, tubeless procedure

Learning Points:

• Flexible ureteroscopy with Thulium and Holmium laser ablation
• Supine US and X-ray guided puncture
• Percutaneous resection of tumor
• Tubeless approach

Clinical History

• 63-year-old woman, heavy smoker
• Right upper calyx urothelial carcinoma Ta, low grade proven by flexible ureteroscopy and biopsy 3 weeks ago
• CT-Urography: 38 mm filling defect, right upper calyx, normal nephrography and urography, normal contralateral kidney
• Chest X-ray: emphysema, no other significant findings
• Cystoscopy: no bladder tumors
• Creatinine: within normal limits
• Urinary culture: negative