Radical nephroureterectomy vs kidney sparing surgery for upper tract urothelial carcinoma in solitary kidney patients: a multi-institutional analysis of the ROBUUST 2.0 registry - Report - MDSpire

Radical nephroureterectomy vs kidney sparing surgery for upper tract urothelial carcinoma in solitary kidney patients: a multi-institutional analysis of the ROBUUST 2.0 registry

  • By

  • Francesco Ditonno

  • Alessandro Veccia

  • Gabriele Bignante

  • Zhenjie Wu

  • Linhui Wang

  • Firas Abdollah

  • Alex Stephens

  • Giuseppe Simone

  • Gabriele Tuderti

  • Randall Lee

  • Daniel D. Eun

  • Andres F. Correa

  • Ottavio De Cobelli

  • Matteo Ferro

  • Francesco Porpiglia

  • Daniele Amparore

  • Enrico Checcucci

  • Antonio Tufano

  • Roberto Contieri

  • Sisto Perdonà

  • Raj Bhanvadia

  • Vitaly Margulis

  • Stephan Brönimann

  • Nirmish Singla

  • James Porter

  • Saum Ghodoussipour

  • Andrea Minervini

  • Andrea Mari

  • Luca Lambertini

  • Alireza Ghoreifi

  • Omri Falik Nativ

  • Mark L. Gonzalgo

  • Daniel Sidhom

  • Chandru P. Sundaram

  • Reuben Ben-David

  • Ahmed Eraky

  • Reza Mehrazin

  • Takashi Yoshida

  • Hidefumi Kinoshita

  • Alireza Dehghanmanshadi

  • Soroush Rais-Bahrami

  • Margaret F. Meagher

  • Dhruv Puri

  • Ithaar H. Derweesh

  • Farshad S. Moghaddam

  • Hooman Djaladat

  • Riccardo Bertolo

  • Riccardo Autorino

  • Alessandro Antonelli

  • September 3, 2025

  • 0 min

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Radical Nephroureterectomy vs Kidney-Sparing Surgery for UTUC in Solitary Kidney Patients

Overview

In patients with a solitary kidney and upper tract urothelial carcinoma (UTUC), kidney-sparing surgery (KSS) demonstrated shorter operative time, less blood loss, and shorter hospital stay compared to radical nephroureterectomy (RNU). Both approaches showed comparable rates of postoperative complications, with RNU patients experiencing a higher incidence of acute kidney injury.

Background

Patients with a solitary kidney present a clinical challenge where preserving renal function must be balanced against oncological control. KSS, including segmental ureterectomy and endoscopic ablation, is a viable option even for high-risk UTUC patients. RNU remains necessary for tumors unsuitable for KSS or in patients with end-stage renal disease, but results in anephric status requiring lifelong dialysis. The ROBUUST 2.0 registry provides multicenter data to inform treatment decisions in this rare patient population.

Data Highlights

ParameterRNU (n=39)KSS (n=12)p-value
Median Age (years)80 (76-81.5)70 (66-78)0.006
Operative Time (min)244.5 (165.5-353.5)162.5 (109.5-270)0.102
Estimated Blood Loss (mL)200 (100-366)100 (50-100)0.013
Length of Stay (days)7.5 (5-12)3 (2-5)<0.001
Any Grade Complications (%)35.9%41.7%1.0
Major Complications (≥CD III) (%)20.5%8.3%0.666
Postoperative Acute Kidney Injury (%)100%16.7%Not significant

Key Findings

  • Patients undergoing RNU were significantly older than those undergoing KSS (median 80 vs 70 years, p=0.006).
  • Operative time was longer for RNU (median 244.5 min) compared to KSS (162.5 min), though not statistically significant (p=0.102).
  • Estimated blood loss was significantly higher in RNU (200 mL) than KSS (100 mL), p=0.013.
  • Length of hospital stay was significantly longer after RNU (7.5 days) versus KSS (3 days), p<0.001.
  • Rates of any grade and major postoperative complications were similar between RNU and KSS groups.
  • Postoperative acute kidney injury occurred in all RNU patients but only 16.7% of KSS patients, without a statistically significant difference in complication types.

Clinical Implications

For patients with a solitary kidney and UTUC, KSS offers a less invasive alternative to RNU with reduced operative blood loss and shorter hospitalization, while maintaining comparable complication rates. The high incidence of acute kidney injury following RNU underscores the importance of renal function preservation in this population. Treatment decisions should consider tumor characteristics and patient comorbidities to optimize oncological and functional outcomes.

Conclusion

This multicenter analysis suggests that kidney-sparing surgery is a feasible and potentially advantageous option for UTUC patients with a solitary kidney, balancing oncological control with renal function preservation. Further long-term studies are warranted to confirm these findings and guide clinical practice.

References

  1. ROBUUST 2.0 Registry Analysis 2015-2024 -- Surgical Outcomes in Solitary Kidney UTUC Patients
  2. Clavien-Dindo Classification 2004 -- Standardized Complication Grading
  3. CKD-EPI 2021 Formula -- eGFR Calculation Method

Original Source(s)

Radical nephroureterectomy vs kidney sparing surgery for upper tract urothelial carcinoma in solitary kidney patients: a multi-institutional analysis of the ROBUUST 2.0 registry

  • by Francesco Ditonno, Alessandro Veccia, Gabriele Bignante, Zhenjie Wu, Linhui Wang, Firas Abdollah, Alex Stephens, Giuseppe Simone, Gabriele Tuderti, Randall Lee, Daniel D. Eun, Andres F. Correa, Ottavio De Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Enrico Checcucci, Antonio Tufano, Roberto Contieri, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Stephan Brönimann, Nirmish Singla, James Porter, Saum Ghodoussipour, Andrea Minervini, Andrea Mari, Luca Lambertini, Alireza Ghoreifi, Omri Falik Nativ, Mark L. Gonzalgo, Daniel Sidhom, Chandru P. Sundaram, Reuben Ben-David, Ahmed Eraky, Reza Mehrazin, Takashi Yoshida, Hidefumi Kinoshita, Alireza Dehghanmanshadi, Soroush Rais-Bahrami, Margaret F. Meagher, Dhruv Puri, Ithaar H. Derweesh, Farshad S. Moghaddam, Hooman Djaladat, Riccardo Bertolo, Riccardo Autorino, Alessandro Antonelli

  • September 3, 2025

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