Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma

The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases (ICUD) publication on UTUC stratified treatment allocations based on high- and low-risk groups. This report updates the conservative management of the low-risk group.

The ICUD for low-risk UTUC working group performed a thorough review of the literature with an assessment of the level of evidence and grade of recommendation for a variety of published studies in this disease space. We update these publications and provide a summary of that original report.

There are no prospective randomized controlled studies to support surgical management guidelines. A risk-stratified approach based on clinical, endoscopic, and biopsy assessment allows selection of patients who could benefit from kidney-preserving procedures with oncological outcomes potentially similar to radical nephroureterectomy with bladder cuff excision, with the added benefit of renal function preservation. These treatments are aided by the development of high-definition flexible digital URS, multi-biopsies with the aid of access sheaths and other tools, and promising developments in the use of adjuvant topical therapy.

Recent developments in imaging, minimally invasive techniques, multimodality approaches, and adjuvant topical regimens and bladder cancer prevention raise the hope for improved risk stratification and may greatly improve the endoscopic treatment for low-risk UTUC.

World journal of urology. 2016 May 27 [Epub ahead of print]

Rao S Mandalapu, Mesut Remzi, Theo M de Reijke, Vitaly Margulis, J Palou, A Kapoor, Ofer Yossepowitch, Jonathan Coleman, Olivier Traxer, J Kyle Anderson, James Catto, Jean de la Rosette, Timothy O'Brien, Anthony Zlotta, Surena F Matin

, Houston, TX, USA., LKH Korneuburg, Korneuburg, Austria., AMC University Hospital, Amsterdam, The Netherlands., Department of Urology, University of Texas Southwestern, Dallas, TX, USA., Fundacio Puigvert, Barcelona, Spain., McMaster University, Hamilton, ON, Canada., Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel., Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Hôpital Tenon, Université Pierre et Marie Curie Paris 6, Paris, France., University of Minnesota Medical Center, Minneapolis, MN, USA., Academic Urology Unit, University of Sheffield, Sheffield, UK., AMC University Hospital, Amsterdam, The Netherlands., Guy's and St. Thomas' NHS Foundation Trust, London, UK., Mt. Sinai Hospital, Toronto, ON, Canada., Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA. .