Upper tract urothelial carcinoma: can the tumor be removed en bloc?

Diagnosis and treatment of upper tract urothelial carcinoma (UTUC) remain important problems of clinical urology. UTUC en bloc i.e. in one-piece removal during organ-sparing surgery is still hardly possible. The most typical endourological operations are either electrosurgery, holmium or thulium YAG laser tumor vaporization.We present a clinical case of ureteroscopic en bloc UTUC removal using a new super pulse thulium fiber laser (SPTFL, FiberLase U3). Recent innovations and trends in this field are also discussed. The technical steps of en bloc ureteroscopic tumor removal allowing for diagnosis verification, identification of pT stage and surgical margin are described. The further innovations in laser UTUC removal include modulation of laser pulse length and development of the correlation between preoperative tumor characteristics and possibility of en bloc removal.