Laparoscopic Nephroureterectomy in a Patient With Hypofunctional Left Kidney and History of Ipsilateral Partial Nephrectomy: A Case Report and Review of the Literature

Upper tract urothelial cancer (UTUC) represents a rare malignant urothelial disease arising from the inner surface of the ureter, the calyces or the renal pelvis. This case report describes a 67-year-old patient with a hypofunctional left kidney who was diagnosed with UTUC. This patient had undergone ipsilateral open partial nephrectomy for renal cell carcinoma two years ago. The peculiarities of our case are the therapeutic dilemma of selecting kidney-sparing surgery or radical nephroureterectomy (RNU) for high-risk UTUC in a single functioning kidney and the implementation of a laparoscopic RNU in an already operated field, rendering the operation extremely challenging. Diagnostic ureteroscopy (URS) revealed a large tumor in the right renal pelvis which extended and filled the upper calyces. Three weeks after the diagnostic URS, the patient underwent laparoscopic RNU. The total operative time was 2 hours and 36 minutes, while the estimated blood loss was 150 ml. Postoperatively the creatinine count ranged from 2.6 to 5.1 mg/dL. In this case report, laparoscopic RNU was feasible and effective for a patient with UTUC who has undergone previous kidney intervention. Although the endoscopic management of even high-risk UTUCs must be considered in patients with hypofunctional or single-functioning kidneys, the oncological safety of the patient must be also taken into consideration. The discussion with the patient about the advantages and the drawbacks of both approaches, and his perspective about quality of life are key points for the selection of the therapeutic approach.