1. INTRODUCTION
1.1. Aim and scope
This overview represents the updated European Association of Urology (EAU) Guidelines for the management of upper urinary tract urothelial carcinoma (UTUC). Separate EAU guidelines 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 references/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 patient representative. Members of this panel have been selected based on their expertise and to represent the professionals treating patients suspected of harbouring urothelial carcinoma (UC). All involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU website Uroweb: https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/panel/.
1.3. Available publications
A quick reference document, the Pocket Guidelines is available online and in print. This is an abridged version which may require consultation together with the full text version. Several scientific publications are available, the most recent scientific summary was published in 2021 [4]. All documents are accessible through the EAU website: https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/.
1.4. Publication history & summary of changes
The first EAU Guidelines on UTUC were first published in 2011. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates. The 2024 UTUC Guidelines presents an update of the 2023 version.
1.4.1. Summary of changes
For the 2024 UTUC Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. Key changes include the addition of:
- New text and guidelines updates in section 3.2.2 on the genetic risk factors and the implications of identifying lynch syndrome’s related UTUCs, and in section 3.4 on the molecular background of UTUCs;
- new text updates in section 6.1.2.2 on tumour location, multifocality, size and hydronephrosis;
- updates in section 6.2 on the risk stratification for clinical decision making, both in text and evidence;
- key updates to the text, evidence and guidelines in section 7.3.2 on the management of distant metastases.