# Management of Upper Tract Urothelial Carcinoma in a Double Collecting System Kidney

## TL;DR

This paper reviews rare cases of kidney cancer in a double collecting system and presents a new robotic surgery approach for treatment.

## Contribution

The first reported case of robot-assisted hemi-nephroureterectomy for complete DCS with single-moiety urothelial carcinoma.

## Key findings

- 34 patients with 35 renal units of UTUC in DCS were analyzed to guide personalized treatment.
- Robotic hemi-NU was successfully performed for a 69-year-old female with high-grade UTUC in a complete DCS.
- Standardized treatment for UTUC in DCS remains challenging due to its rarity and underreporting.

## Abstract

Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC.