title: "Extreme" renal preservation: neoadjuvant chemotherapy and percutaneous resection for upper-tract urothelial carcinoma in a patient with solitary kidney--a case report.
abstract: OBJECTIVE
  Renal preservation in selected patients with upper-tract urothelial cancer (UTUC) has been well described, offering an alternative to radical nephroureterectomy. We present our experiences in performing percutaneous treatments after neoadjuvant chemotherapy in one such patient with a large, complex, high-grade UTUC in a solitary kidney.
  
  
  METHODS
  A 55-year-old woman with a solitary kidney presented with a 5.2 cm enhancing mass with calcifications involving the left renal pelvis and lower pole. Cystoscopy and retrograde pyelography demonstrated normal bladder mucosa. Ureteroscopy revealed a large, papillary tumor occupying the renal pelvis. Ureteroscopic treatment was deemed impossible because of the lesion's volume. We proceeded with percutaneous resection after downsizing the tumor after a course of neoadjuvant chemotherapy. Using a 25F resectoscope via a percutaneous tract, resection was performed to fully excise the tumor, and the patient received two postoperative chemotherapy courses. A recurrence developed within an isolated calix 8 months postoperatively, which was also managed percutaneously.
  
  
  CONCLUSIONS
  A multimodal approach in a highly motivated patient could represent a reasonable strategy for patients in whom such a therapy is desired.
authors: Department of Urology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA.
authors: Steve K
authors: SK
authors: Williams
authors: Christopher
authors: C
authors: Atalla
authors: Reza
authors: R
authors: Ghavamian
authors: Cy
authors: C
authors: Stein
authors: David M
authors: DM
authors: Hoenig
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009926:Organ Preservation; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D019459:Urothelium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery