陳子双¹、鄭元佐¹

¹高雄長庚紀念醫院 外科部 泌尿科

Tzu-Shuang Chen¹,Yuan-Tso Cheng¹

¹Divisions of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

 

Purpose: Radical nephroureterectomy (RNU) with the excision of bladder cuff has been considered the standard treatment for upper urinary tract urothelial carcinoma (UTUC). However, RNU in patients with solitary kidney results in dialysis-dependent could worsen quality of life and patient survival. We reported a patient of renal pelvis tumor in solitary kidney refused RNU and was managed with complete resection of renal pelvis tumor followed by uretero-pyeloplasty .

Case presentation: This 79-year-old male was a victim of urothelial cancer in bladder and right renal pelvis had received right RNU 15 years ago. Clinical symptom is painless gross hematuria for 2 months. Computed tomography (CT) of abdomen demonstrated mild left hydronephrosis with irregular soft tissue mass in uretero-pelvic junction about 1.3x2.0cm, favoring urothelial tumor. After discussed with the patient, he refused RNU in fearing dialysis-related comorbidity and was managed with renal pelvis resection and uretero-pyeloplasty. His renal function is well persevered with eGFR=79.6. Pathologic study showed single invasive papillary urothelial carcinoma in renal pelvis with periureteral invasion, but without surgical margin involvement, pT3. Adjuvant chemotherapy is feasible with good renal function. There is no recurrence on CT follow-up in sixth month post operation.

Conclusions: Though high risk of disease progression/recurrence may compromise local cancer control. Nephron-sparing surgery offer satisfactory quality of life and is surgical feasible in selected patient. Recent guidelines have suggest this decision will have to be made on a case-by-case basis with the patient considering a balance between cancer control and RNU comorbidity.