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 - Scorecard - 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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Clinical Scorecard: Comparison of Radical Nephroureterectomy and Kidney-Sparing Surgery for Upper Tract Urothelial Carcinoma in Patients with a Single Kidney: Insights from the ROBUUST 2.0 Registry Analysis

At a Glance

CategoryDetail
ConditionUpper Tract Urothelial Carcinoma (UTUC) in patients with a solitary kidney
Key MechanismsSurgical treatment options include Radical Nephroureterectomy (RNU) and Kidney-Sparing Surgery (KSS) balancing oncological control and renal function preservation
Target PopulationPatients with UTUC and a single functioning kidney
Care SettingTertiary referral centers with experienced urological surgeons

Key Highlights

  • KSS is a viable option even for high-risk solitary kidney patients, aiming to preserve renal function.
  • RNU is often necessary for tumors unsuitable for KSS or in patients with end-stage renal disease, but leads to anephric status requiring lifelong hemodialysis.
  • Perioperative outcomes show shorter operative time, less blood loss, and shorter hospital stay with KSS compared to RNU, with similar rates of postoperative complications.

Guideline-Based Recommendations

Diagnosis

  • Use scheduled follow-up with quarterly urinary cytology and cystoscopy for the first two years post-surgery.
  • Perform quarterly CT scans during the first year and annual assessments thereafter.
  • Adhere to international guideline recommendations for endoscopic follow-up in KSS patients.

Management

  • Select RNU for tumors not amenable to KSS or patients with ESRD.
  • Consider KSS, including segmental ureterectomy and endoscopic ablation, to preserve renal function in solitary kidney patients.
  • Perform surgeries by experienced urological surgeons using standardized techniques.

Monitoring & Follow-up

  • Monitor serum creatinine and estimated glomerular filtration rate (eGFR) preoperatively, at discharge, 3 and 12 months postoperatively, and at last follow-up.
  • Use Clavien-Dindo classification to grade intraoperative and postoperative complications.
  • Conduct oncological surveillance with recurrence-free survival, metastasis-free survival, cancer-specific survival, and overall survival assessments.

Risks

  • RNU leads to anephric status requiring lifelong hemodialysis, significantly impacting quality of life.
  • Postoperative acute kidney injury occurred in all RNU patients versus a minority in KSS patients.
  • Similar rates of major postoperative complications observed between RNU and KSS.

Patient & Prescribing Data

51 patients with solitary kidney undergoing surgical treatment for UTUC (39 RNU, 12 KSS)

KSS patients were younger with better baseline CKD stage distribution; KSS associated with shorter operative time, less blood loss, and shorter hospital stay; similar complication rates compared to RNU.

Clinical Best Practices

  • Carefully balance oncological control with renal function preservation when selecting surgical approach in solitary kidney patients.
  • Employ robotic surgery approaches where feasible for both RNU and KSS to optimize perioperative outcomes.
  • Implement rigorous postoperative monitoring of renal function and oncological status according to standardized protocols.

References

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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