Emerging strategies: conservative management of upper tract urothelial carcinoma

Current Opinion in Urology
April 2025

Urothelial Cancer Awareness Month Peer Reviewed Articles

Abstract

Purpose of review

Upper tract urothelial carcinoma (UTUC) is a rare yet aggressive malignancy, representing 5–10% of urothelial cancers. While radical nephroureterectomy (RNU) has traditionally offered excellent oncological control, it compromises renal function. Recent advancements have shifted the paradigm toward kidney-sparing strategies in select cases. This review highlights innovations in UTUC diagnosis and conservative management, focusing on emerging imaging techniques, noninvasive biomarkers, and minimally invasive treatments.

Recent findings

Advances in multiparametric MRI and radiomics have improved diagnostic accuracy and risk stratification. Moreover, noninvasive biomarkers – including circulating tumor DNA, microRNAs, and urinary methylation assays – provide promising tools for early detection and surveillance. Kidney-sparing approaches such as endoscopic laser ablation and segmental ureterectomy have demonstrated comparable oncologic outcomes in low-risk patients. Moreover, topical therapies, including intracavitary treatments like UGN-101, offer a promising minimally invasive option.

Summary

The conservative management of UTUC is evolving, driven by advancements in imaging, molecular diagnostics, and minimally invasive treatments. While kidney-sparing approaches are increasingly utilized in low-risk patients, further prospective studies are needed to validate their efficacy.

KEY POINTS

CT urography and ureteroscopy remain the standard for UTUC diagnosis, while emerging imaging and noninvasive biomarkers may enhance accuracy.
Kidney-sparing strategies, including endoscopic treatment and topical therapies, are increasingly utilized in select UTUC patients.
Radiomics and liquid biopsy technologies show promise for improving UTUC risk stratification and treatment decision-making.
Bladder recurrence after diagnostic ureteroscopy remains controversial, with ongoing research into mitigation strategies.
Further prospective studies are needed to validate the long-term oncologic outcomes of conservative UTUC management.

Emerging strategies: conservative management of upper tract urothelial carcinoma

Abstract

Purpose of review

Recent findings

Summary

KEY POINTS

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Emerging strategies: conservative management of upper tract urothelial carcinoma

Abstract

Purpose of review

Recent findings

Summary

KEY POINTS

You might also like:

Expression of HER2 in urothelial carcinoma and its significance

Novel Computational Pipeline Enables Reliable Diagnosis of Inverted Urothelial Papilloma and Distinguishes It From Urothelial Carcinoma

Differences in the expression heterogeneity of ADC-related markers between primary tumors and metastatic lymph nodes in advanced urothelial cancers.

Germline genetic variants in cancers of the bladder, renal pelvis, ureter, or urethra.

Real world effectiveness of systemic treatment in patients (pts) with advanced upper tract urothelial carcinoma (UTUC) with histological variants.

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