Conservative treatment of upper urinary tract tumors with Nd:YAG laser

Diagnosis of upper tract filling defects sometimes presents a difficult dilemma. In many patients, a direct endoscopic approach may permit both diagnosis and treatment. Patients (n = 28) suspected of having malignancies or with known upper tract filling defects underwent ureteropyeloscopy. Malignancy was confirmed in 18 patients, who underwent treatment of the urothelial tumors and the tumor bases with Nd:YAG laser irradiation (25-30 W; 3 seconds). The follow-up included endoscopic surveillance every 3 months. Ten patients remain tumor free after 6 to 30 months (mean 15 months). Eight patients who had recurrences underwent a new laser irradiation followed by intracavitary therapy with mitomycin C. Only one nephrectomy has been necessary, and no cases of disseminated disease have been found. A ureteropyeloscopic approach coupled with Nd:YAG laser irradiation is a useful treatment for selected patients with upper tract urothelial tumors. In the future, the indications may expand.