孤立性上段輸尿管原位癌之保腎治療：結合節段切除術與逆行性卡介苗療法

管乙融、于大雄、卓育慶

三軍總醫院 外科部 泌尿科

A Nephron-Sparing Approach to Isolated Upper-Ureter Carcinoma In Situ: Combining Segmental Resection with Retrograde BCG Therapy

Yi-Rong Guan, Dah-Shyong Yu, Yu-Cing Jhuo

Department of Urology, Tri-service General Hospital

Abstract:  Upper tract urothelial carcinoma in situ (CIS) is uncommon, and isolated CIS confined strictly to the ureter is exceptionally rare. While radical nephroureterectomy and bladder cuff excision remains the standard treatment for high-risk disease, kidney-sparing management may be considered for carefully selected patients with localized disease and a strong need for renal preservation. We presented a case of intermittent gross painless hematuria and a suspicious left upper-ureter lesion with associated hydronephrosis. Ureteroscopy with ureteral biopsy suggested urothelial carcinoma. Given the patient’s young age and the localized nature of the lesion, a kidney-sparing segmental ureterectomy with ureteroureterostomy was performed. Final pathology confirmed CIS confined to a 1.5 cm segment with negative surgical margins. Postoperatively, monthly ureteral catheter-assisted retrograde intraureteral BCG instillation was initiated to reduce the risk of local recurrence. A follow-up ureteroscopy 6 months later showed no evidence of recurrence. This case demonstrates that for highly selected patients, segmental ureterectomy is a feasible alternative to radical nephroureterectomy, and adjuvant retrograde intraureteral BCG instillation can provide short-term oncologic control while preserving vital renal function.