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World J Nephrol. Mar 6, 2016; 5(2): 158-165
Published online Mar 6, 2016. doi: 10.5527/wjn.v5.i2.158
Upper tract urothelial carcinoma: Paradigm shift towards nephron sparing management
Julia V Fiuk, Brad F Schwartz
Julia V Fiuk, Brad F Schwartz, Division of Urology, Southern Illinois University School of Medicine, Springfield, IL 62794, United States
Author contributions: Both the authors contributed equally to the conceptualization, research, writing and editing of this manuscript.
Conflict-of-interest statement: Neither author (Julia V Fiuk or Brad F Schwartz) have any conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Julia V Fiuk, MD, Division of Urology, Southern Illinois University School of Medicine, 301 N 8th St, 4th Floor, PO Box 19665, Springfield, IL 62794, United States. jfiuk@siumed.edu
Telephone: +1-217-5457217 Fax: +1-217-5457305
Received: June 12, 2015
Peer-review started: June 15, 2015
First decision: July 10, 2015
Revised: November 11, 2015
Accepted: January 27, 2016
Article in press: January 29, 2016
Published online: March 6, 2016
Processing time: 263 Days and 9 Hours
Abstract

Upper tract urothelial carcinoma (UTUC) is relatively rare compared to urothelial carcinoma of the lower tract, comprising only 5%-10% of all urothelial cancers. Although both entities share histologic properties, UTUC tends to be more invasive at diagnosis and portend a worse prognosis, with a 5 year overall mortality of 23%. To date, the gold standard management of UTUC has been radical nephroureterectomy (RNU), with nephron sparing techniques reserved for solitary kidneys or cases where the patient could not tolerate radical surgery. Limited data from these series, as well as select series where nephron-sparing endoscopic management has been offered to a broader patient base, suggest that minimally invasive, nephron sparing techniques can offer comparable oncologic and survival outcomes to RNU in appropriately selected patients. We review the current literature on the topic and discuss long term outcomes and sequelae of the gold standard treatment, RNU. We also discuss the oncologic outcomes of minimally invasive, endoscopic management of UTUC. Our goal is to provide the reader a comprehensive overview of the current state of the field in order to inform and guide their treatment decisions.

Keywords: Urothelial carcinoma; Ureteroscopy; Upper tract; Endoscopy; Minimally invasive

Core tip: In the appropriate patient population, minimally invasive endoscopic treatment of upper tract urothelial carcinoma provides comparable oncologic and survival outcomes to the gold standard radical nephroureterectomy.