This protocol addresses low-risk upper urinary tract urothelial carcinoma in patients who have undergone kidney-sparing endoscopic management, but in whom complete tumour resection was not achieved or residual/recurrent disease was identified on second-look ureteroscopy within eight weeks of initial treatment.
All of the following features must be present to characterise the low-risk sub-population in which kidney-sparing management is initially indicated:
The preceding treatment — kidney-sparing management via endoscopic ablation using flexible ureteroscopy with holmium and/or thulium laser, or percutaneous management for renal pelvis tumours, or distal ureterectomy for distal ureteral disease, followed by second-look ureteroscopy within eight weeks — aimed to achieve complete tumour resection with no residual or recurrent disease.
This protocol is indicated when those goals were not met.
When kidney-sparing endoscopic management fails to achieve the required oncological endpoints, the approach moves to a definitive surgical procedure targeting the kidney and ureter. The complete protocol specifies the operative scope and associated technical details.
DOI: 10.1016/j.eururo.2025.02.023
Unifocal disease, Tumour size <2 cm, Negative for high-grade cytology, Low-grade URS biopsy, No invasive aspect on CT. All of these factors need to be present.
For low-risk cancers, kidney-sparing surgery is the preferred approach, as survival is similar to that after RNU.
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