Nephron Sparing Surgery in Urothelial Cell Cancer of upper Urinary Tract (uUT)

Ch. Lang
Clinic of Urology, Knappschaftshospital Sulzbach
Academic Teaching Hospital of Saar University, Germany

Urothelial carcinomas are the fourth most common tumours. They can be located in the lower (bladder and urethra) or the upper (pyelocaliceal cavities and ureter) urinary tract. Bladder tumours account for 90–95% of Urothelial Cancers. Urothelial carcinomas of the uUT are uncommon and account for only 5–10% of Urothelial Cancers with an estimated annual incidence in Western countries of almost two cases per 100,000 inhabitants.
Whereas in renal cell cancer meanwhile kidney sparing surgery is the common standard of care if ever possible, organ preserving strategies in urothelial carcinoma of upper urinary tract are challenging the previous rules respecting the risk characteristics of these tumours and the leak of defined surgical procedures and instruments as treatment option up to now.

Based on cases of my department surgical options in kidney sparing surgery using open and endoscopic approach are demonstrated and their outcome: partial Nephrectomy, partial Ureterectomy and Retrograde Intrarenal Surgery (RIRS) using flexible Scopes.

Treatment paradigm is slowly including Nephron Sparing Management in Urothelial Cancer of upper Urinary Tract.
Outcome data are retrospective from selected patients, depending on favourable tumour characteristics and patient co-morbidities, but seems to be equivalent concerning oncological result.
All cases of my department benefit from kidney preserving strategies.
Endoscopic instruments and technics are developed and save in practice.
Nephron Sparing Surgery has the potential for first line treatment in selected patients with low risk.