Kidney-sparing approach for upper tract urothelial carcinoma: An update on current evidence

Ivan Ching Ho Ko, Chris Ho Ming Wong, David Ka Wai Leung, Alex Qin-yang Liu, Kevin Cheuk Kin Cheng, Brian Wai Hei Siu, Steffi Kar Kei Yuen, Nikhil Vasdev, Keiichiro Mori, Karl H. Tully, Dmitry Enikeev, Anthony Chi-Fai Ng, Jeremy Yuen-Chun Teoh

Research output: Contribution to journalReview articlepeer-review

Abstract

Objective
This article reviews the latest updates and outcomes of kidney-sparing surgery (KSS) in patients with upper tract urothelial carcinoma (UTUC).
Methods
A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years. Key search words included “Upper urinary tract tumour/cancer/carcinoma”, “kidney-sparing surgery or approach”, “endoscopic treatment for upper tract tumour/cancer/carcinoma”, “topical instillation in the upper urinary tract”, and “urinary marker for urothelial carcinoma”. References within the identified literature were explored and evaluated for relevance.
Results
KSS is recommended for both low-risk and select high-risk UTUCs with imperative indication such as solitary kidney. Studies have shown comparable oncological outcomes after KSS including endoscopic ablation, segmental ureterectomy, and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases. The development of novel diagnostics tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.
Conclusions
Kidney sparing approach for UTUC is an evolving and promising area in urologic oncology, driven by advance in technology, better diagnostic tools, and novel therapeutic agents. Our article provides a comprehensive review of the latest advancements and clinical recommendations. While current evidence is mainly based on retrospective studies, prospective trials are required to address important but unanswered clinical questions in this field.
Original languageEnglish
JournalAsian Journal of Urology
Early online date2 Dec 2024
DOIs
Publication statusE-pub ahead of print - 2 Dec 2024

Keywords

  • Upper tract urothelial carcinoma
  • Kidney-sparing approach
  • Segmental ureterectomy
  • Topical instillation in upper tract
  • Endoscopic treatment

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