Nephron-Sparing Approaches in Upper Tract Urothelial Carcinoma: Current and Future Strategies

Abstract

Upper tract urothelial carcinoma (UTUC) is a relatively rare cancer, and much of the approach to treatment has been derived from strategies employed in treating bladder cancer. Radical nephroureterectomy (RNU) is regarded as the gold standard treatment for UTUC. However, due to potential complications, such as renal function impairment, that can affect oncologic outcomes, the demand for nephron-sparing treatment to effectively treat cancer while preserving renal function has increased. As a result, various treatment methods for low-grade, low-volume UTUC, such as segmental ureterectomy, endoscopic resection, and intraluminal therapy, have been attempted and reported. Although these treatment modalities have exhibited acceptable oncological results, further studies are required. In the future, the introduction of new technologies, such as improved diagnostic and surgical equipment, and new drug delivery systems, could enhance the effectiveness of nephron-sparing strategies in the treatment of UTUC. Additionally, understanding the biological and genetic characteristics of UTUC that distinguish it from those of bladder cancer will also aid in establishing strategies for nephron-sparing.

Endoscopic intervention versus radical nephroureterectomy for the management of localized upper urinary tract urothelial carcinoma: a systematic review and meta-analysis of comparative studies

“…Historically, kidney-sparing surgeries (KSS), including endoscopic ablation/resection and segmental ureterectomy, were offered only in selected cases such as those with a solitary kidney, chronic kidney disease, or bilateral disease [ 7 ]. KSS was primarily recommended for patients with low-grade tumors and guaranteed satisfactory oncological radicality [ 8 ]. According to the latest systematic review and meta-analysis, there was no significant difference in overall survival and cancer-specific survival between patients who underwent RNU and those who received endoscopic KSS (E-KSS) [ 9 ].…”

Current Evidence on Utility, Outcomes, and Limitations of Endoscopic Laser Ablation for Localized Upper Urinary Tract Urothelial Carcinoma: Results from a Scoping Review

“…According to the current European Association of Urology guidelines, the standard treatment for localized high-risk disease is radical nephroureterectomy (RNU) with bladder cuff excision or distal ureterectomy that may be associated with similar oncological outcomes to RNU but with lower morbidity [2] . Indeed, RNU can result in postoperative renal function impairment, leading to a potential decrease in the estimated glomerular filtration rate by 20–25% and an associated risk of developing chronic kidney disease, which can negatively impact overall survival (OS) [3] .…”

Machine learning models combining computed tomography semantic features and selected clinical variables for accurate prediction of the pathological grade of bladder cancer

“…It requires initial endoscopic treatment and monitoring. However, some cases of low-grade BCa can be invasive ( 6 , 7 ). High-grade BCa has a high malignant potential associated with rapid progression and high mortality ( 8 , 9 ).…”