When is kidney removal surgery recommended for upper tract urothelial cancer?

Upper tract urothelial cancer begins in the lining of the renal pelvis or ureter. The usual extensive operation, called radical nephroureterectomy, removes the affected kidney, the ureter, and a small area where the ureter joins the bladder. Doctors assess tumour grade, size, location, growth pattern, urine-cell findings, imaging, lymph nodes, and the health of the opposite kidney. A kidney-sparing approach may be considered for selected, lower-risk tumours or when preserving kidney function is especially important.

Ask whether urine cytology, a camera examination of the urinary tract, scans, and kidney-function tests are needed. Give the team a complete medicine list and mention blood thinners, previous urinary procedures, kidney disease, and allergies. Discuss whether a kidney-sparing option is suitable, how the bladder will be checked, and what follow-up is planned. Learn more about [Kidney Removal Surgery](/treatments/surgical-oncology/nephrectomy/).

Seek prompt medical advice for visible blood in the urine, clots, inability to pass urine, fever with urinary symptoms, severe side or abdominal pain, or persistent vomiting. After surgery, contact the team urgently for fever, worsening wound changes, reduced urine, increasing pain, chest pain, or breathlessness. Severe breathing difficulty, confusion, or collapse requires emergency care.

What makes this tumour high or lower risk? Could a kidney-sparing procedure treat it safely? What exactly would be removed? How will the other kidney be assessed and protected? How often will the bladder and urinary tract be checked afterward?