Kidney sparing surgery for upper-tract urothelial carcinoma

Radical nephroureterectomy (RNU) is the gold standard treatment for bulky, high-grade, or muscle invasive upper-tract urothelial carcinoma (UTUC). Kidney sparing approaches, however, have increasingly played a role in the management of UTUC in both imperative and elective settings. The impetus to conservative treatment is driven in part by sequelae of chronic kidney disease (or even end-stage renal disease) following RNU. Kidney preserving treatments include segmental ureteral resection (including distal ureterectomy) as well as percutaneous or retrograde ureteroscopic endoscopic ablation. Contemporary studies highlight that these may be appropriate in select patients with relatively small, solitary, low risk upper-tract tumors. Bladder and ipsilateral upper-tract recurrences can occur following nephron-sparing treatments for UTUC, thereby underscoring the need to maintain a rigorous compliance program with radiographic and endoscopic surveillance in these patients.