Successful multidisciplinary management of non-muscle-invasive upper tract urothelial carcinoma in a patient with HIV and concurrent staghorn calculus: a case report

The coexistence of upper tract urothelial carcinoma (UTUC) and human immunodeficiency virus (HIV) infection poses unique diagnostic and therapeutic challenges. Literature on the perioperative management and outcomes of curative surgery for UTUC in people living with HIV (PLWH), particularly when complicated by conditions such as staghorn calculi, is exceptionally scarce. A 65-year-old male presented with a 1-week history of urinary frequency and urgency. Two months prior, he had undergone ureteroscopic laser lithotripsy for a left staghorn calculus (details unavailable) with ureteral stent placement at another institution. During preoperative evaluation for residual stones, his HIV screening returned positive, prompting referral to our center. A subsequent percutaneous nephrolithotomy revealed and permitted resection of a renal pelvic neoplasm. Pathology indicated non-invasive, low-grade papillary urothelial carcinoma. HIV infection was confirmed. Following optimized preoperative management—including nutritional support, urinary tract infection control, and initiation of antiretroviral therapy—the patient successfully underwent laparoscopic left radical nephroureterectomy with bladder cuff excision, combined with cystoscopy and stent removal. Final pathology confirmed non-invasive, low-grade papillary urothelial carcinoma (pTaN0M0) with negative margins. This case demonstrates that a meticulously coordinated, multidisciplinary approach—encompassing nutritional optimization, infection control, antiretroviral therapy management, and expert surgical planning—enables the safe and effective execution of curative laparoscopic radical surgery for UTUC in PLWH, even when complicated by concurrent conditions such as complex renal calculi. This report contributes a valuable, albeit limited, evidence base for managing this specific patient population.