The first joint session of the European Association of Urology (EAU) and the Société Internationale d’Urologie (SIU) discussed risk stratification, conservative management and surgical approaches to urothelial carcinomas, with lively discussion and enthusiastic participation from the audience.
“Upper urinary tract carcinomas, and particularly their risk stratification, are a very new topic”, Prof. Morgan Roupret (FR) emphasized during his talk on risk stratification in upper tract urothelial carcinomas (UTUCs). While there is a low incidence, particularly when compared with bladder urothelial cancers, the array of treatment options is still large. Focussing on specific elective cases, when the patient has two functioning kidneys, Roupret stressed the benefits of conservative management, adding that the patient “must follow a stringent approach, and very precisely”.
Prof. Chris Heyns (ZA) and Prof. Joachim Thüroff (DE), co-chairs of this session, then opened the floor for Prof. Jean de la Rosette (NL) to expand upon the subject of conservative management of UTUCs. He presented research on new tools, such as optical coherence tomography (OCT) and endoluminal ultrasound (ELUS). He added that these new methods, particularly a combination of OCT and ELUS, would provide more and better information about the patient’s condition. With this knowledge, it will be easier to select cases and subsequent options for treatment. Some of these approaches, based on the field of cardiology, are still very new. While they are promising, “we cannot guarantee they can be offered to all patients. Treatment is expensive, although it can be a worthwhile investment”.
Novel diagnostics and treatment approaches to high grade upper tract urothelial carcinoma were discussed next by Prof. Arnulf Stenzl (DE). His talk touched upon four main topics: the open or laparoscopic debate, RNU or parenchymal sparing surgery and segmental resection, bladder cuff management, and lymphadenectomy. He underlined the factors that increase the risk of metastases, in particular the location of the tumour. He closed his participation with the reflection that “upper urinary tract carcinoma is a thorny issue, and we should not overestimate what we know”.
The role of lymph node dissection, and robotic surgery in urothelial carcinomas were also debated in this session. The morning closed with notes by Prof. Thüroff on patient selection and technical tips in the case of continent urinary diversion. The topic of UTUC still has room for research, and more details are available in the updated EAU Guidelines on Urothelial Carcinomas of the Upper Urinary Tract.