Upper Tract Urothelial Carcinoma (UTUC)

Upper Tract Urothelial Carcinoma (UTUC) is a rare type of cancer that affects the lining of the renal pelvis and ureter—the parts of the urinary tract that carry urine from the kidney to the bladder. UTUC can be aggressive and requires prompt diagnosis and treatment.

Symptoms

• Blood in urine (hematuria)
• Flank or back pain
• Frequent urinary tract infections
• Obstruction of urine flow

Diagnosis

• Urine cytology to detect cancer cells
• CT Urography or MRI for detailed imaging
• Ureteroscopy with biopsy to confirm tumor type

Treatment

Laparoscopic Nephroureterectomy is the gold standard treatment for UTUC. This minimally invasive surgery involves removing:

• The affected kidney
• The entire ureter
• A small portion of the bladder cuff to ensure complete tumor removal

Benefits of Laparoscopic Approach:

• Smaller incisions and faster recovery
• Reduced postoperative pain
• Precise removal of tumor with excellent oncological outcomes
• Shorter hospital stay

Other Treatment Considerations

• In selected low-risk UTUC cases, kidney-sparing procedures may be considered
• Adjuvant chemotherapy may be recommended in advanced disease

Kidney-Sparing Surgery for Low-Risk UTUC

For low-risk UTUC, especially tumors located in the distal ureter, a kidney- sparing approach may be considered instead of removing the entire kidney and ureter.

Distal Ureterectomy

• Surgical removal of only the affected portion of the distal ureter along with a small bladder cuff.
• Preserves the kidney and surrounding healthy ureter.
• Typically followed by reimplantation of the ureter into the bladder. Benefits
• Maintains kidney function
• Minimally invasive options available (laparoscopic or robotic)
• Reduced surgical morbidity compared to full nephroureterectomy

Follow-Up

• Close monitoring with urine cytology and imaging is essential to detect recurrence.
• May be combined with adjuvant intravesical therapy in selected cases.