TY - JOUR
T1 - "Extreme" renal preservation
T2 - Neoadjuvant chemotherapy and percutaneous resection for upper-tract urothelial carcinoma in a patient with solitary kidney - A case report
AU - Williams, Steve K.
AU - Atalla, Christopher
AU - Ghavamian, Reza
AU - Stein, Cy
AU - Hoenig, David M.
PY - 2013/4/1
Y1 - 2013/4/1
N2 - Background and Purpose: Renal preservation in selected patients with upper-tract urothelial cancer (UTUC) has been well described, offering an alternative to radical nephroureterectomy. We present our experiences in performing percutaneous treatments after neoadjuvant chemotherapy in one such patient with a large, complex, high-grade UTUC in a solitary kidney. Case Report: A 55-year-old woman with a solitary kidney presented with a 5.2 cm enhancing mass with calcifications involving the left renal pelvis and lower pole. Cystoscopy and retrograde pyelography demonstrated normal bladder mucosa. Ureteroscopy revealed a large, papillary tumor occupying the renal pelvis. Ureteroscopic treatment was deemed impossible because of the lesion's volume. We proceeded with percutaneous resection after downsizing the tumor after a course of neoadjuvant chemotherapy. Using a 25F resectoscope via a percutaneous tract, resection was performed to fully excise the tumor, and the patient received two postoperative chemotherapy courses. A recurrence developed within an isolated calix 8 months postoperatively, which was also managed percutaneously. Conclusion: A multimodal approach in a highly motivated patient could represent a reasonable strategy for patients in whom such a therapy is desired.
AB - Background and Purpose: Renal preservation in selected patients with upper-tract urothelial cancer (UTUC) has been well described, offering an alternative to radical nephroureterectomy. We present our experiences in performing percutaneous treatments after neoadjuvant chemotherapy in one such patient with a large, complex, high-grade UTUC in a solitary kidney. Case Report: A 55-year-old woman with a solitary kidney presented with a 5.2 cm enhancing mass with calcifications involving the left renal pelvis and lower pole. Cystoscopy and retrograde pyelography demonstrated normal bladder mucosa. Ureteroscopy revealed a large, papillary tumor occupying the renal pelvis. Ureteroscopic treatment was deemed impossible because of the lesion's volume. We proceeded with percutaneous resection after downsizing the tumor after a course of neoadjuvant chemotherapy. Using a 25F resectoscope via a percutaneous tract, resection was performed to fully excise the tumor, and the patient received two postoperative chemotherapy courses. A recurrence developed within an isolated calix 8 months postoperatively, which was also managed percutaneously. Conclusion: A multimodal approach in a highly motivated patient could represent a reasonable strategy for patients in whom such a therapy is desired.
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U2 - 10.1089/end.2012.0521
DO - 10.1089/end.2012.0521
M3 - Article
C2 - 23442142
AN - SCOPUS:84876159391
SN - 0892-7790
VL - 27
SP - 427
EP - 431
JO - Journal of Endourology
JF - Journal of Endourology
IS - 4
ER -