Nephroureterectomy for Upper Tract Urothelial Carcinoma: Indications and Technique

Radical nephroureterectomy (RNU) remains the gold standard treatment for upper tract urothelial carcinoma (UTUC). In the present chapter, we discuss indications and preparation for surgery, including the use and timing of both systemic and intravesical chemotherapy. We discuss our operative technique in performing RNU, which has largely shifted to a minimally invasive approach at our institution. Based on contemporary evidence concerning the perioperative use of intravesical chemotherapy, we routinely instill intravesical mitomycin C intraoperatively at the time of RNU and excise the bladder cuff to decrease intravesical recurrence. We also typically approach lymph node dissection in a templated fashion, particularly in high-risk patients. Finally, we provide tips to avoid and manage common complications that may arise during or following RNU.