Surgery for upper urinary tract urothelial cancer (UTUC)

This is the most commonly used operation to treat UTUC. The surgeon removes:

• the kidney
• a layer of fat around the kidney
• the ureter
• an area of tissue where the ureter enters the bladder (bladder cuff).

In keyhole surgery to remove the whole kidney and ureter, the surgeon makes 3 to 5 small cuts. They pass a laparoscope through one of the cuts. One of the cuts may be bigger so that the surgeon can remove the kidney and ureter. 

The surgeon may also remove some lymph nodes close to the kidney to check whether they contain cancer cells. 

You will have a tube (catheter) put in during the operation to drain urine from your bladder. This may be removed before you leave hospital. But you may go home with it still in place to let your bladder heal.

You may have one dose of chemotherapy into the bladder after your surgery. This is to help prevent the cancer coming back. This is called intravesical chemotherapy. If you have a low risk of the cancer coming back, you usually do not need chemotherapy.

If you have keyhole surgery, you may stay in hospital for 2 to 5 days. If you have open surgery, you may stay in hospital for 5 to 7 days.

Removing a kidney and ureter is a big operation. It is not suitable for everyone. Your doctors may need to do tests to check you are well enough to cope with the surgery. 

You can live a normal life with just one kidney. It will be able to do the work of both kidneys.

Removing part of the ureter (segmental resection)

You usually have this type of surgery only if the cancer is in the lower third of the ureter.

The surgeon removes the part of the ureter where the tumour is. They also remove a healthy area (margin) of ureter above the tumour and all the ureter below the tumour. Then they reattach the remaining ureter to the bladder.

This is less common than having the whole kidney and ureter removed.

Endoscopic surgery

It is sometimes possible to remove a low-grade, early-stage tumour in the renal pelvis using endoscopy. The surgeon passes a flexible tube called an endoscope up through the urethra, bladder and ureter to the renal pelvis. This is called a ureteroscopy. The surgeon then removes the tumour using tools passed through the endoscope.

Sometimes the surgeon makes a small cut in your back to reach the kidney (percutaneous renoscopy). They then pass the endoscope into the kidney to reach the renal pelvis.

You may have endoscopic surgery for higher-grade cancers if you only have one kidney. Or you may have it if your kidneys do not work well enough for you to cope with just one.

Endoscopic tumour ablation

If the cancer is low grade and only growing on the lining of the ureter, you may have it removed by laser or heat treatment (diathermy). This is called ablation. 

A doctor passes a ureteroscope into the bladder and into the ureter. They then apply a beam of laser or heat to the tumour to destroy it.

Sometimes a tube (stent) may be left in the ureter for a time to keep it open.

If you have laser or heat treatment, you will be very closely monitored afterwards. This is because there is a risk the cancer could grow back. If this happens, it is important the cancer is found as soon as possible.

See also:

• Recovery after surgery