Kidney-Sparing Approaches in Upper Tract Urothelial Cancer: A Narrative Review

Area of Science:

• Urology
• Oncology
• Nephrology

Background:

• Upper tract urothelial carcinoma (UTUC) is a rare cancer.
• Radical nephroureterectomy (RNU) was the standard but causes renal dysfunction.
• Kidney-sparing surgery (KSS) is emerging as an alternative.

Purpose of the Study:

• To review recent evidence on nephron-sparing techniques for UTUC.
• To examine parameters for refining patient selection for KSS.
• To discuss novel and future KSS approaches.

Main Methods:

• Literature review of nephron-sparing techniques for UTUC.
• Analysis of clinical, radiologic, and molecular parameters for risk stratification.
• Evaluation of novel therapies like UGN-101 and photodynamic therapy.

Main Results:

• Endoscopic ablation shows similar survival to RNU in low-risk UTUC but higher recurrence.
• Segmental/total ureterectomy preserve renal function with comparable oncologic outcomes to RNU.
• Novel therapies demonstrate promising early results.

Conclusions:

• KSS is a viable alternative to RNU for select UTUC patients, preserving renal function.
• Perioperative therapies and biomarkers may expand KSS indications.
• Long-term outcomes and personalized treatment algorithms require further investigation through multicenter studies.