Endoscopy: Minimal-Invasive Treatment Approach of Bilateral Upper Tract Urothelial Carcinoma Associated with Lynch Syndrome-A Case Report

Background: Upper tract urothelial carcinomas (UTUCs) are infrequent neoplasms occurring in the pelvis renalis or the ureter with an incidence between 5% and 10% of all urothelial carcinomas. In addition, a synchronous bilateral appearance is extremely rare with a quantity of only 1.6% of all UTUCs. Since an oncologically-safe treatment would be a radical nephroureterectomy, consequently leading to dialysis, a satisfying therapy is challenging. Case Presentation: We present the case of a 64-year-old woman with bilateral UTUCs at primary diagnosis and the sincere wish of a kidney-preserving treatment option. Therefore, multiple endoscopic ablations with a laser were performed, until a tumor-free status could be achieved. Owing to her medical history with a gynecologic tumor, a genetic examination was initiated, revealing the diagnosis of a Lynch syndrome. Based on promising results in the first 3-month follow-up we decided on a short-term endoscopic follow-up to keep control of tumor progression by endoscopic ablations when needed. In this way we are trying to spare our patient the dialysis. Conclusions: An oncologically satisfying treatment for bilateral UTUCs stays a challenging problem in urology. Despite little available data and expected high recurrence rates, we decided on an endoscopic kidney-preserving therapy approach to eventually spare our patient the dialysis. Up to now we are pleasantly surprised about the result and since a short-term follow-up is possible in our department, we hope to attain endoscopic control of the tumor. In addition, we want to point out that genetic background might be underestimated and should be keep it in mind for special cases. In this way, an early detection of other related tumors or tumor detection in relatives could be possible through preventive checkups.