Current Status in the Surgery and Conservative Management of Upper Urinary System Tumors

Abstract

Upper urinary tract urothelial cancers constitute 5% of all urothelial cancers and standard therapy is bladder cuff excision with nephroureterectomy. This treatment is performed as open or technologically assisted (laparoscopic and robotic) surgery. Conservative treatment approaches include endoscopic treatments, segmental resection, and upper urinary tract immunotherapy. Upper urinary tract immunotherapy is considered effective in patients with carcinoma in situ. In addition, the development of targeted molecules and gene therapies is also anticipated. In selected patient groups, endoscopic (antegrade percutaneous and retrograde ureteroscopic) procedures are being implemented as an alternative to nephroureterectomy in order to prevent unnecessary organ loss and to preserve the nephrons. Oncological survival and tumor control with the endoscopic approach are similar to the outcomes of radical surgery in cases with low-stage and grade tumors. Advantages of the endoscopic approach include minimal morbidity and preservation of kidney function, while disadvantages include lifelong follow-up and the need for a large number of endoscopies. In cases with a large tumor burden, the retrograde ureteroscopic approach is generally preferred instead of percutaneous treatment.