多發性輸尿管低惡性度尿路上皮癌之腎臟保留治療：病例報告

楊承翰、曹智維、卓育慶    

三軍總醫院泌尿外科

Kidney-Sparing Management of Multifocal Low-Grade Urothelial Carcinoma of the Ureter: A Case Report

Cheng-Han Yang, Chih-Wei Tsao, Yu-Cing Jhuo     

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China    

Purpose:

A solitary low-grade urothelial carcinoma limited to the ureter is particularly uncommon. Kidney-sparing treatment is generally considered in selected low-risk cases; however, its role in patients with multifocal ureteral lesions is lesser. We report a 62-year-old woman who presented with painless gross hematuria. Initial evaluation showed no bladder tumor on cystoscopy, and urine cytology was negative. Early imaging suggested a left upper ureteral stone, but persistent hematuria and subsequent studies revealed left hydronephrosis and ureteral obstruction.

Diagnostic ureteroscopy was performed because of persistent obstruction and hematuria, and a double-J stent was placed for decompression. On repeated ureteroscopic evaluation, a lesion over the left upper-third ureter was identified and biopsy revealed low-grade urothelial carcinoma. Subsequent ureteroscopy demonstrated multiple ureteral lesions, and repeat biopsy again confirmed non-invasive low-grade urothelial carcinoma. In view of the low-grade and non-invasive pathology, preserved renal function, and the intention to avoid radical nephroureterectomy, a kidney-sparing approach was chosen. The patient underwent flexible ureteroscopic laser ablation of the ureteral tumors followed by intraureteral BCG instillation.

During follow-up, retrograde pyelography and ureteroscopy revealed no papillary lesion, and the patient has remained clinically stable under close surveillance. This case highlights that although multifocal ureteral low-grade urothelial carcinoma is not a typical presentation for conservative management, kidney-sparing treatment may still be a feasible alternative in carefully selected patients when renal preservation is an important consideration.