BERKELEY, CA (UroToday.com) - The case report is an exciting one for us because it reflects an instance of primarily patient-choice-driven therapy for aggressive transitional cell cancer in a solitary kidney, and one with a positive result, to date. It certainly demonstrates the feasibility of renal preservation in a case where a relatively young and motivated patient prioritized all attempts to manage her disease while preserving her solitary kidney, and it underscores the need for a multidisciplinary approach to such complex patients.
On balance, while this case is exciting because the patient has had an excellent outcome to date, it remains a case report only. The growing body of evidence for the value of neoadjuvant chemotherapy in high-grade, upper tract urothelial carcinoma (UTUC) is compelling with respect to disease cure rates in the setting of nephroureterectomy, but application to endoscopic management of UTUC has not yet been well studied. The success that our patient has enjoyed in this case is encouraging, but we are cognizant of the relative risks, the relatively short follow up, and the lack of a large cohort of patients to study for outcomes.
Further prospective studies will be needed to define if the management used in this case is reasonable, safe, and offers significant advantages to a population of patients rather than a single individual, and without compromising cure rates.
David M. Hoenig, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology
Residency Program Director
Chief, Weiler Hospital Division
Co-Director of Fellowship in Robotics, Laparoscopy, and Endourology
Albert Einstein College of Medicine/
Montefiore Medical Center
3400 Bainbridge Ave., 5th floor
Bronx, NY 10467