Rapid Systemic Progression After Ureteroscopic Holmium: YAG Laser Ablation for High‐Grade Upper Tract Urothelial Carcinoma in a Solitary Kidney: A Case Report

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.