ABSTRACT Introduction Endoscopic kidney‐sparing management is increasingly being used for upper tract urothelial carcinoma; however, its use in high‐grade diseases remains challenging. Case Presentation An 82‐year‐old man with a solitary left kidney underwent transurethral lithotripsy for left renal and ureteral stones 25 years after right nephroureterectomy for ureteral carcinoma. A 15‐mm papillary tumor was incidentally detected in the upper calyx and partially ablated using a holmium:YAG laser after biopsy. Biopsy revealed a high‐grade urothelial carcinoma. Because the patient had a solitary kidney, radical nephroureterectomy would have necessitated dialysis. Therefore, ureteroscopic laser ablation was performed after counseling. A second laser ablation was performed 2 months later. Twelve days later, imaging revealed an enlarged renal pelvic tumor with multiple metastases. Despite receiving gemcitabine plus carboplatin chemotherapy, the patient died. Conclusion Ureteroscopic ablation for high‐grade upper tract urothelial carcinoma may offer limited cancer control and can be followed by extremely rapid systemic progression.
Takebe et al. (Fri,) studied this question.