Transitional cell carcinoma of the renal pelvis is managed differently from renal cell carcinoma. For a G3 T2 urothelial carcinoma of the renal pelvis with no distant metastases, the standard surgical treatment is:
- A Nephroureterectomy with excision of the ipsilateral ureteric orifice and cuff of bladder ✓
- B Partial nephrectomy to preserve renal function
- C Radical nephrectomy alone with preservation of the ureter
- D Endoscopic ablation with regular ureteroscopic surveillance
Correct answer: A. Nephroureterectomy with excision of the ipsilateral ureteric orifice and cuff of bladder
Explanation
Upper tract urothelial carcinoma of the renal pelvis/ureter is treated with nephroureterectomy including excision of the distal ureter with a bladder cuff (ureteric orifice excision). This prevents recurrence in the distal ureteric stump, which occurs in 30–40% if the ureter is left in situ. Partial nephrectomy is not oncologically appropriate. Endoscopic management is reserved for low-grade, low-stage, or solitary kidney situations. Radical nephrectomy alone leaves the urothelial lining at risk.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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