What is a Kidney Worth?
Upper urinary tract urothelial carcinoma (UTUC) has traditionally been managed with radical extirpative surgery. However, conservative management with kidney-sparing endoscopic surgery is currently performed not only in those patients with imperative indications but also in those patients with low risk disease and normal, functioning contralateral kidneys, due to its similar oncological efficacy. Recent analyses relevant to our current era of cost-effective management have enabled us to understand the variety of costs associated with preserving a kidney with UTUC. Kidney-sparing surgery for UTUC offers value in delaying progression to chronic kidney disease (CKD), end-stage renal disease (ESRD), and their associated cardiovascular morbidity and mortality. By delaying the progression to CKD and ESRD, conservative endoscopic management of UTUC also effectively reduces ESRD expenditures. The kidney’s worth is ultimately furthered by the elimination of the negative impact of CKD and ESRD on a patient’s quality of life.
KeywordsUpper urinary tract urothelial carcinoma Kidney-sparing surgery Financial costs End-stage renal disease Chronic kidney disease Quality of life
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