Endoscopic management of upper tract urothelial carcinoma with laser ablation including Magneto pulse modulation.

OBJECTIVE: This study aimed to assess the efficacy and safety of different laser technologies, including the new Holmium:YAG (Ho:YAG) Magneto pulse modulation, for the endoscopic ablation of upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: Sixty-eight patients with UTUC from two centres were treated between February 2022 and June 2025. Three different lasers were used based on the available technology in each centre at the time of treatment: Ho:YAG with Vapor Tunnel pulse modulation (VT, Group A), thulium fibre laser (TFL, Group B) and Ho:YAG with Magneto pulse modulation (Mag, Group C). Intraoperative parameters, postoperative complications and recurrence rates were assessed. RESULTS: Mean tumour size was 13.7 mm (range 5-30 mm). The overall mean operative time was 44.3 min. No intraoperative complications occurred. The overall rate of post-procedural complications was 19.1%. The most frequent complication was haematuria, affecting 10.3% of patients. The recurrence rate was 17.6% (12 out of 68 patients) with a mean time to recurrence of 3.3 months. At the last follow-up, 80.9% of patients were alive and free of disease, whereas 11.8% were alive with disease. Mortality due to urothelial carcinoma occurred in 1.5% of patients, whereas 5.8% of patients died from other causes. CONCLUSIONS: Endoscopic laser UTUC ablation is feasible and safe using both Ho:YAG and TFL, including the new Magneto pulse modulation technology. The low complication and recurrence rates support the use of this treatment in highly selected patients.