Kidney-sparing approach for upper tract urothelial carcinoma: An update on current evidence

Objective: This article reviews the latest updates and outcomes of kidney-sparing surgery (KSS) in patients with upper tract urothelial carcinoma (UTUC). Methods: A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years. Key search words included “upper urinary tract tumour/cancer/carcinoma”, “kidney-sparing surgery or approach”, “endoscopic treatment for upper tract tumour/cancer/carcinoma”, “topical instillation in the upper urinary tract”, and “urinary marker for urothelial carcinoma”. References within the identified literature were explored and evaluated for relevance. Results: KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney. Studies have shown comparable oncological outcomes after KSS including endoscopic ablation, segmental ureterectomy, and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases. The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes. Conclusion: Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology, driven by advances in technology, better diagnostic tools, and novel therapeutic agents. Our article provides a comprehensive review of the latest advancements and clinical recommendations. While current evidence is mainly based on retrospective studies, prospective trials are required to address important but unanswered clinical questions in this field.