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 (Chair) M.Burger (Vice-chair), E. Compérat, N.C. Cowan, P. Gontero, A.H. Mostafid, J. Palou, B.W.G. van Rhijn, S.F. Shariat, R. Sylvester, R. Zigeuner
Guidelines Associates: O. Capoun, D. Cohen, J.L. Dominguez-Escrig, B. Peyronnet, T. Seisen, V. Soukup

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 upper urinary tract urothelial carcinoma (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: https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available in print and as an app for iOS and Android 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, the most recent scientific summary was published in 2018 [4]. 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 2019 EAU UTUC Guidelines present a limited update of the 2018 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 2019 print:

  • Section 3.2 – Risk factors, has been expanded
  • Section 4.4 – Future developments, was added
  • Section 5.6 - Summary of evidence and guidelines for the diagnosis of urothelial carcinoma of the upper urinary tract - two recommendations were added.

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


Recommendations

Strength rating

Use CT for staging the chest.

Strong

If CT is contra-indicated, magnetic resonance imaging may be used for imaging the abdomen and pelvis.

Strong


  • Section 7.2.2 – Metastasectomy, has been added
  • Section 7.2.3 – Systemic treatments, has been expanded to include immune checkpoint inhibitors.
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