CONTEXT: The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. OBJECTIVE: To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION: The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract carcinoma, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, adjuvant treatment, instillation, recurrence, risk factors, and survival. References were weighted by a panel of experts. EVIDENCE SYNTHESIS: Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification as well as for radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumour and two functional kidneys. After radical nephroureterectomy, cisplatin-based chemotherapy is indicated in locally advanced UTUC. CONCLUSIONS: These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. PATIENT SUMMARY: Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.

Department of Pathology Sorbonne University Assistance Publique Hôpitaux de Paris Hopital Tenon Paris France

Department of Radiology The Queen Alexandra Hospital Portsmouth UK

Department of Urology Caritas St Josef Medical Center University of Regensburg Regensburg Germany

Department of Urology Caritas St Josef Medical Center University of Regensburg Regensburg Germany; Department of Surgical Oncology Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Fundacio Puigvert Universidad Autonoma de Barcelona Barcelona Spain

Department of Urology Hospital Motol 2nd Faculty of Medicine Charles University Prague Czech Republic; Department of Urology Comprehensive Cancer Centre Medical University of Vienna Vienna Austria; Department of Urology Weill Cornell Medical College New York NY USA; Department of Urology University of Texas Southwestern Dallas TX USA; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Department of Urology Hospital Motol 2nd Faculty of Medicine Charles University Prague Czech Republic; Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Medical University of Graz Graz Austria

Department of urology university of Rennes Rennes France

Division of Urology Molinette Hospital University of Torino School of Medicine Torino Italy

EAU Guidelines Office Arnhem The Netherlands

Royal Surrey Hospital Guildford UK

Urology Fundación Instituto Valenciano de Oncología Valencia Spain

Urology General Teaching Hospital and 1st Faculty of Medicine Charles University Praha Prague Czech Republic

Urology GRC n°5 Predictive ONCO URO Pitié Salpêtrière Hospital AP HP Sorbonne University Paris France

Urology Royal Free London NHS Foundation Trust Royal Free Hospital London UK

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Eur Urol. 2021 Jan;79(1):80-81. doi: 10.1016/j.eururo.2020.09.045. PubMed

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