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 (NMIBC) [1], muscle-invasive and metastatic bladder cancer (MIBC) [2], and primary urethral carcinoma (PUC) [3].
It must be emphasised that clinical Guidelines present the best evidence available to the experts, but following guidelines 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 - including 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 EAU Guidelines Panel on UTUC consists of an international multidisciplinary group of clinicians, including urologists, uro-oncologists, a pathologist and patient representatives. Members of this Panel have been selected based on their expertise and to represent the professionals treating patients suspected of harbouring urothelial carcinoma (UC). Everyone involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU website: https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/panel/.
1.3. Available publications
A quick reference document (Pocket Guidelines) is available online and in print, presenting the main findings of the UTUC Guidelines. This reference document is an abridged version that may require consultation together with the full text version. Several scientific publications are available; the most recent scientific summary was published in 2025 [4]. All documents are accessible on the EAU website: https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/. An EAU Guidelines App for iOS and Android devices is also available containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, guidelines cheat sheets, and links to the full text guidelines.
1.4. Publication history and summary of changes
The first EAU Guidelines on UTUC were published in 2011. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates. The 2026 UTUC Guidelines presents a limited update of the 2025 version.
1.4.1. Summary of changes
For the 2026 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:
- In Section 3.4, the prognostic value of fibroblast growth factor receptor (FGFR) 3 expression in UTUC is discussed.
- In Chapter 4, the 9th edition (2025) of the Tumour, Node, Metastasis (TNM) classification is incorporated.
- In Section 5.4, the evidence base related to cytology and urinary biomarkers is developed to provide greater clarity.
- In Section 7.1.2, the lack of data related to both renal preservation after endoscopic treatment and ablation performed with lasers is discussed.
- In Section 7.2.1.a.2, techniques related to bladder cuff management are elaborated upon.
- In Section 7.2.1.a.3, the patient criteria for lymph node dissection (LND) are discussed.
- In Section 7.2.1.b.1, two retrospective studies related to distal ureterectomy are added.
- In Section 7.2.2.a.3, a study related to chemoimmunotherapy is included.
- In Section 7.2.2.b.2, a study related to the use of adjuvant bladder instillations in a preoperative setting is included.
- In Section 7.3.1, the options related to the treatment of patients with clinical locoregional lymph node (LN) metastases, and the evidence in this regard, are discussed.
- In Chapter 8, the recommendations for the follow-up of UTUC in patients with high-risk tumours after kidney-sparing management are updated.