Current Kidney-Preserving Strategies for Upper Tract Urothelial Carcinoma

Radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) poses significant challenges due to the impact on renal function. A kidney-sparing strategy (KSS) is considered for patients with low-risk disease or compromised renal function to avoid the morbidity associated with RNU. Endoscopic management, including ureteroscopy with laser ablation, offers a minimally invasive approach for low-grade, small tumors, preserving renal function while achieving cancer control. Segmental ureteral resection is suitable for only selected cases, balancing oncologic efficacy with nephron preservation. Intracavitary instillations of mitomycin or Bacille Calmette-Guerin (BCG) enhance local control in carefully selected patients. Advances in imaging and biomarkers improve patient selection and monitoring after KSS. These strategies require multidisciplinary coordination to optimize outcomes while preserving renal function. Long-term surveillance is essential due to high recurrence rates. Kidney-preserving approaches, when appropriately applied, improve quality of life and reduce surgery-related morbidity while maintaining oncologic control in patients with UTUC. In this manuscript, we discuss the potency of improved outcomes based on our experience.