Mieke Bus

1 11 Figure 2: Radical Nephroureterectomy specimen, including bladder cuff. This surgery provides excellent disease control since the complete affected system is removed. Unfortunately, estimated Glomerular Filtration Rate (eGFR) decreases significantly in patients with UTUC following nephroureterectomy. The ultimate chronic kidney disease (CKD) is associated with a significant increase in cardiovascular events and death of any cause, independent of co-existing comorbidities. 2-5 Because of this significant increase in mortality and morbidity due to CKD, renal parenchyma sparing endoscopic treatment by laser ablation is nowadays accepted in a selected group of patients (figure 3). Major advantage of this treatment is preservation of renal function. In addition, the patient is spared the morbidity associated with radical surgery. Historically, endoscopic treatment of UTUC was preserved for imperative cases like renal insufficiency, anatomical or functional solitary-kidney, bilateral disease and for those who are not fit to undergo radical surgery. Nowadays, conservative endoscopic treatment becomes also more accepted in elective cases of patients with a normal functioning contralateral kidney. A B Figure 3: Upper urinary tract tumour on Ureterorenoscopy. (a) pyelumtumour visualized during diagnostic URS before laser vaporisation. In the left the laser fiber is visible. (b) pyelum lesion after laser vaporisation of the tumour.