Endoscopic Treatment of UTUC

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