BACKGROUND AND OBJECTIVE: We present a summary of the 2025 update for the European Association of Urology (EAU) guidelines for upper urinary tract urothelial carcinoma (UTUC). The aim is to provide practical recommendations on the clinical management of UTUC with a focus on diagnosis, treatment, and follow-up. METHODS: For the 2025 guidelines on UTUC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS: Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with UTUC. The guidelines stress the importance of appropriate treatment taking into account patient values and preferences. Key updates in the 2025 UTUC guidelines include: significant changes to the recommendations for UTUC diagnosis; complete revision of the sections addressing risk stratification, ureteroscopy, and the surgical approach for radical nephroureterectomy; addition of four new recommendations, two related to kidney-sparing management of localised low-risk UTUC and a further two related to management of high-risk nonmetastatic UTUC; a review and adaptation of recommendation for UTUC follow-up; and addition of a new section addressing quality indicators for UTUC management. CONCLUSIONS AND CLINICAL IMPLICATIONS: This overview of the 2025 EAU guidelines on UTUC offers valuable insights into risk factors, diagnosis, classification, treatment, and follow-up for UTUC. The guidelines contain information on the management of individual patients according to the current best evidence and are designed for effective integration in clinical practice.

Department of Pathology Medical University of Vienna Vienna Austria

Department of Surgical Oncology Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Bichat Claude Bernard Hospital AP HP Université de Paris Paris France

Department of Urology Città della Salute e della Scienza University of Torino School of Medicine Torino Italy

Department of Urology Comprehensive Cancer Center Vienna General Hospital Medical University of Vienna Vienna Austria

Department of Urology Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK

Department of Urology Fundación Instituto Valenciano de Oncología Valencia Spain

Department of Urology General University Hospital and 1st Faculty of Medicine Charles University Praha Prague Czechia

Department of Urology St Louis Hospital AP HP Université de Paris Paris France

Department of Urology UROSUD La Croix Du Sud Hospital Quint Fonsegrives France

Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Edinburgh Bladder Cancer Surgery University of Edinburgh Western General Hospital Edinburgh UK

Fight Bladder Cancer Chinnor UK; World Bladder Cancer Patient Coalition Brussels Belgium

GRC 5 Predictive Onco Uro Sorbonne University Paris France; Department of Urology Pitie Salpetriere Hospital AP HP Paris France

Guidelines Office European Association of Urology Arnhem The Netherlands

Institution of Translational Medicine Lund University Malmö Sweden; Department of Urology Skåne University Hospital Malmö Sweden

Patient representative European Association of Urology Arnhem The Netherlands

Rosemere Cancer Centre Lancashire Teaching Hospitals NHS Foundation Trust Preston UK; University of Manchester Manchester UK; University of Central Lancashire Preston UK

S H Ho Urology Centre Department of Surgery Faculty of Medicine Chinese University of Hong Kong Hong Kong China

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