Urothelial-cell carcinoma and solitary kidney: outcomes with renal-sparing management.

PURPOSE

To review our experience with renal-sparing approaches for upper-tract transitional-cell carcinoma (UT-TCC) associated with solitary kidneys.

PATIENTS AND METHODS

Ten patients with UT-TCC associated with solitary kidneys who were managed with renal-sparing approaches from 2000 to 2004 were identified. Patient data were gathered retrospectively, and a patient interview was conducted. A literature review was performed, and our results were compared with those from selected other authors. The mean follow-up was 33 months.

RESULTS

Eight patients (80%) developed recurrence after initial treatment necessitating further intervention. The average number of procedures was nine per patient, and an average of two cycles of topical therapy was given. At the end of the follow-up period, 6 patients (60%) were disease free. Of these 6 patients, 2 (33%) required interval nephroureterectomy because of disease progression in one and renal insufficiency leading to dialysis in the other. Metastatic disease occurred in four patients during the surveillance interval, including one patient with a nephrostomy-site recurrence. Three patients died from their disease during the follow-up period, and one patient remained alive after chemotherapy. The overall survival rate was 70% at 33 months. Of the living patients, 6 (86%) could be reached for comment, and all were very satisfied with their renal-sparing management.

CONCLUSIONS

Renal-sparing approaches remain an option in motivated patients with solitary kidneys and UT-TCC. Patients should realize that management tends to involve multiple procedures that are associated with potential morbidity, entails lifetime follow-up, and often requires long-term nephrostomy access for topical treatment or relief of obstruction. Long-term patient quality-of-life and cancer-specific outcomes for renal- sparing management compared with quality-of-life and survival on dialysis are unknown.