Hemodynamic instability related to renal bleeding, complete ureteral tears or pelvic avulsions or leakage of urine into the peritoneal cavity are imperative indications for laparotomy.
Unfortunately, the authors fail to delineate the type of patients who fit in the category of "imperative indications".
As a result, SUICR might be a valuable alternative to RNU for patients with high-grade distal upper urinary tract recurrence and imperative indications.
This technique provides a valid alternative to nephroureterectomy for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.
In aggregate, SUICR provides a valid alternative to RNU for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.
Selecting patients who would benefit more from this technique remains a challenge, and the technique is generally only recommended for patients with imperative indications.
We congratulate Haferkamp et al. 1 for their work trying to identify prognostic factors predictive of survival for patients with renal cell carcinoma (RCC) who undergo nephron-sparing surgery for imperative indications.
Of great interest is also the finding that patients who underwent nephron-sparing surgery for imperative indications did not have a significantly worse prognosis than the RN group, even though they probably tended to have more serious comorbidities.
On the other hand, our study stands out in that we could assess whether PN was performed for elective or imperative indications even though this definition was not based on hard criteria but the individual subjective surgeon's appraisal (based on the number of kidneys, renal function and comorbidities).
This dogma has changed dramatically in recent years [ 1] because a large number of studies have shown that PN for elective or imperative indications is a technically feasible and safe surgical procedure with an only slightly higher complication rate [ 6, 8, 26].
