Percutaneous Resection of High-Volume Upper Tract Urothelial Carcinoma

Abstract

Clinical History:

A 55-year-old male with hyperlipidemia, gastric sleeve surgery, and appendectomy was evaluated for upper tract urothelial carcinoma (UTUC). Referred for microscopic hematuria work-up, a left renal calyceal/pelvic tumor was discovered. He was asymptomatic with no history of fever, weight loss, or other constitutional symptoms and denied recent tobacco use, having quit ten years ago after a 20-year smoking history.

Physical Examination:

The examination revealed a well-groomed gentleman in no acute distress. Vitals were normal, and abdominal examination showed no tenderness, masses, or distention.

Diagnosis:

CT urogram showed a sizeable renal pelvis tumor on the left with patchy enhancement in the renal parenchyma. Pathological review post percutaneous resection identified high-grade noninvasive urothelial carcinoma with papillary growth.

Intervention:

The patient underwent cystoscopy with endoscopic resection of the left renal pelvis tumor, antegrade nephrostogram, and placement of a left nephrostomy tube. Techniques included retrograde pyelogram, biplanar fluoroscopy for renal access, cold cup biopsy for mass debulking, and bipolar electrocautery for hemostasis and tumor bed fulguration. Drains included a left percutaneous nephrostomy and a Foley catheter.

Follow-Up/Outcomes:

The operation lasted 90 minutes with an estimated blood loss of 15 mL. The patient’s postoperative course was uneventful; the catheter was removed on postoperative day (POD) #2, and a CT scan showed expected postoperative changes. He was discharged on POD#3 with the nephroureteral tube capped. Final pathology confirmed high-grade noninvasive urothelial carcinoma. A decision was made to proceed with neoadjuvant chemotherapy before subsequent nephroureterectomy.

Disclosure:

No author disclosure.

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Runtime of video: 4 min 56 sec.