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Upper urinary tract urothelial carcinoma
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of upper urinary tract urothelial carcinoma are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the Japanese Urological Association (JUA 2024), the American Urological Association (AUA/SUO 2023), and the American Urological Association (AUA 2021).
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Classification and risk stratification
Diagnostic investigations
Clinical assessment: as per EAU 2025 guidelines, elicit a medical and family history based on the Amsterdam II criteria to screen patients with UTUC for Lynch syndrome.
B
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Laboratory testing
Urinary cytology
Diagnostic imaging
Imaging for staging
Diagnostic procedures
Cystoscopy and ureteroscopy
As per EAU 2025 guidelines:
Perform urethrocystoscopy to rule out bladder tumor.
A
Perform diagnostic ureteroscopy if imaging and voided urine cytology are not sufficient for the diagnosis and/or risk-stratification of patients with suspected UTUC.
A
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Histopathology
Medical management
General principles: as per EAU 2025 guidelines, discuss all patients with suspected upper tract urothelial carcinoma on imaging in a multidisciplinary team meeting.
A
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Watchful waiting
Neoadjuvant therapy
Adjuvant therapy (platinum-based)
Adjuvant therapy (nivolumab)
Adjuvant therapy (pembrolizumab)
Definitive therapy (first-line therapy)
Definitive therapy (second-line therapy)
Definitive therapy (maintenance therapy)
Palliative care
Therapeutic procedures
Kidney-sparing interventions: as per EAU 2025 guidelines, offer kidney-sparing management as primary treatment option in patients with low-risk tumors.
A
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Pelvicalyceal chemotherapy
Pelvicalyceal BCG
Surgical interventions
Patient education
General counseling
As per AUA/SUO 2023 guidelines:
Provide patients with a description of the short- and long-term risks associated with recommended diagnostic and therapeutic options, including the need for endoscopic follow-up, clinically significant strictures, toxicities associated with surgical treatment, and side effects from neoadjuvant and adjuvant therapies.
B
Discuss disease-related stresses and risk factors and encourage patients with urothelial cancer to adopt healthy lifestyle habits, including smoking cessation, exercise, and a healthy diet, to promote long-term health benefits and QoL.
E
Follow-up and surveillance
Surveillance after kidney-sparing management
As per EAU 2025 guidelines:
Perform cystoscopy and obtain CT urography at 3 and 6 months and annually thereafter for 5 years in patients with low-risk tumors. Perform ureteroscopy at 3 months if no second-look ureteroscopy was performed.
B
Perform second-look ureteroscopy and cytology at 6 weeks. Use similar follow-up principles as for high-risk disease treated with radical nephroureterectomy if no residual tumor is found.
B
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Surveillance after nephroureterectomy