Kidney-Sparing Percutaneous Management of High-Grade Upper Tract Urothelial Carcinoma in a Functionally Solitary Kidney: A 24-Month Follow-Up

Abstract

Introduction: High-grade upper tract urothelial carcinoma (UTUC) is generally treated with radical nephroureterectomy. Kidney-sparing treatment may be considered in selected patients with imperative indications.
Aim: To present the clinical course and 24-month outcome of percutaneous nephroscopic ablation of high-grade UTUC in a patient with a functionally solitary kidney and Lynch syndrome.
Materials and Methods: We describe a case of high-grade non-invasive papillary UTUC in a woman in her late seventies who declined radical surgery because it would have resulted in permanent dialysis dependence. Following unsuccessful ureteroscopic management, percutaneous holmium:YAG laser ablation and adjuvant mitomycin C instillation were performed.
Results and Discussion: The renal pelvic tumor was macroscopically ablated without major perioperative complications. During intensive surveillance with computed tomography urography, ureterorenoscopy, and selective urinary cytology, no recurrence or progression was detected over 24 months, and renal function remained stable.
Conclusion: Percutaneous kidney-sparing treatment may be a feasible option in highly selected imperative cases of high-grade UTUC when radical surgery would result in dialysis dependence. This approach requires multidisciplinary decision-making, careful counseling, and strict long-term surveillance.