Upper Urinary Tract Urothelial Cell Carcinoma

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

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M. Rouprêt, M. Babjuk, M. Burger, E. Compérat, N. Cowan, P. Gontero, A.H. Mostafid, J. Palou, B.W.G. van Rhijn, S.F. Shariat, R. Sylvester, R. Zigeuner
Guidelines Associates: J.L. Dominguez-Escrig, B. Peyronnet, T. Seisen

1.INTRODUCTION

1.1.Aim and objectives

The European Association of Urology (EAU) Non-muscle-invasive Bladder Cancer (NMIBC) Guidelines Panel has compiled these clinical guidelines to provide urologists with evidence-based information and recommendations for the management of urothelial carcinoma of the upper urinary tract (UTUC). Separate EAU guidelines documents are available addressing non-muscle-invasive bladder cancer [1], muscle-invasive and metastatic bladder cancer (MIBC) [2], and primary urethral carcinoma [3].

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The European Association of Urology (EAU) Guidelines Panel on NMIBC consists of an international multidisciplinary group of clinicians, including urologists, uro-oncologists, a radiologist, a pathologist and a statistician. Members of this panel have been selected based on their expertise and to represent the professionals treating patients suspected of harbouring urothelial carcinoma. All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU website Uroweb: http://uroweb.org/guideline/upper-urinary-tracturothelial-cell-carcinoma/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available in print and in a number of versions for mobile devices, presenting the main findings of the UTUC Guidelines. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available as are a number of translations of all versions of the EAU UTUC Guidelines. All documents are accessible through the EAU website Uroweb: http://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/.

1.4.Publication history & summary of changes

The first EAU guidelines on UTUC were published in 2011. The 2017 EAU guidelines on UTUC present a limited update of the 2016 version.

1.4.1.Summary of changes

The literature for the complete document has been assessed and updated, whenever relevant.

Conclusions and recommendations have been rephrased and added to throughout the current document.

Key changes for the 2017 print:

New section 3.3.1.1 - Summary of evidence for Chapter 3 (Epidemiology, aetiology and pathology) has been added.

3.3.1.1Summary of evidence for histology and classification

Summary of evidence

LE

A small proportion of upper tract urothelial carcinoma belong to the tumour spectrum of the hereditary non-polyposis colorectal cancer.

3

New section 5.3 - Summary of evidence section has been added to the Guidelines for the diagnosis of upper tract urothelial carcinoma.

5.3Summary of evidence and guidelines for the diagnosis of upper tract urothelial carcinoma

Summary of evidence

LE

The diagnosis of urothelial carcinoma of the upper urinary depends on computed tomography urography.

2

Selective urinary cytology has high sensitivity in high-grade tumours including carcinoma in situ.

3

New section 7.1.2.4 – Summary of evidence section has been added to the Guidelines for radical nephroureterectomy.

7.1.2.4Summary of evidence and guidelines for radical nephroureterectomy

Summary of evidence

LE

Radical nephroureterectomy is the standard in high-risk upper tract urothelial carcinoma, regardless of tumour location.

2

Open and laparoscopic approaches have equivalent efficacy and safety in T1–2/N0 upper tract urothelial carcinoma.

2

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