"Extreme" renal preservation: Neoadjuvant chemotherapy and percutaneous resection for upper-tract urothelial carcinoma in a patient with solitary kidney - A case report

Steve K. Williams, Christopher Atalla, Reza Ghavamian, Cy Stein, David M. Hoenig

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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.

Original languageEnglish (US)
Pages (from-to)427-431
Number of pages5
JournalJournal of Endourology
Issue number4
Publication statusPublished - Apr 1 2013


ASJC Scopus subject areas

  • Urology

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