單一腎患者合併不完全雙套輸尿管之上尿路尿路上皮癌的腎臟保留手術：病例報告與病例系列分析

林奕豪、裘坤元、陳正哲、楊涵中、楊晨洸、李建儀

台中榮民總醫院 泌尿醫學部

Kidney-Sparing Surgery for Upper Tract Urothelial Carcinoma in a Solitary Kidney with Incomplete Ureteral Duplication: A Case Report and Case Series Analysis

Yi-Hao Lin, Kun-Yuan Chiu, Cheng-Che Chen, Han-ChungYang, Cheng-Kuang Yang,  Jian-Ri Li

Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan

Introduction:

Radical nephroureterectomy (RNU) is still a standard treatment procedure for upper tract urothelial carcinoma (UTUC). Management of UTUC in patients with a solitary kidney presents a significant clinical challenge, as RNU may lead to renal failure and dialysis dependence. Kidney-sparing strategies are therefore essential in selected cases to preserve renal function while maintaining oncologic control.

Case Presentation:

We report an 85-year-old woman with a history of left nephroureterectomy for UTUC 3 years ago who subsequently developed a metachronous urothelial carcinoma in the upper moiety ureter of an incomplete duplicated collecting system in her solitary right kidney. Imaging revealed focal ureteral wall thickening, and ureteroscopic biopsy confirmed low-grade urothelial carcinoma about 1 cm.

This patient underwent kidney-sparing surgery via a laparoscopic hand-assisted approach. After nephrectomy and immediate cold perfusion, ex vivo bench surgery was performed, including tumor excision for the upper moiety ureter followed by end-to-side and upper-to-lower ureteroureterostomy for reconstruction of the duplicated system. The kidney was subsequently autotransplanted into the iliac fossa with vascular anastomosis and restoration of urinary continuity to the distal ureter.

Outcome

The total warm ischemia time was 15 minutes 39 seconds, and the estimated blood loss was 100 mL. The procedure was successfully completed with restoration of renal perfusion and preservation of urinary continuity. This patient tolerated the procedure well. Postoperatively, the renal function was preserved, with serum creatinine levels changing from 1.8 to 2.1 mg/dL(eGFR from 24.8 to 21.55 mL/min/1.73㎡)

In addition, a case series was analyzed to assess graft kidney failure time and tumor location to further characterize outcomes of kidney-sparing management.

Conclusion:

Renal autotransplantation with ex vivo tumor resection represents a feasible kidney-sparing option for selected patients with UTUC in a solitary kidney, particularly in complex anatomical conditions such as ureteral duplication. Careful patient selection and multidisciplinary planning are essential to optimize outcomes.