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 and 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). 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/.
A 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 extended guidelines.
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 2025 UTUC Guidelines presents an update of the 2024 version.
1.4.1. Summary of changes
For the 2025 UTUC Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. This resulted in the inclusion of 17 updated studies across the Guidelines. Key changes include:
- Significant changes to the recommendations for the diagnosis of UTUC in section 5.7.
- Complete revision of Chapter 6 Risk stratification.
- Complete revision of section 7.1.2 Ureteroscopy.
- The addition of two new recommendations to section 7.1.7 related to kidney-sparing management of localised low-risk UTUC.
- Complete revision of section 7.2.1.1 Surgical approach for radical nephroureterectomy.
- The addition of two new recommendations to section 7.2.5 related to management of high-risk non-metastatic UTUC.
- Review and adaption of the section 8.1 recommendations for the follow-up of UTUC.
- Addition of a new chapter addressing quality indicators for the management of UTUC, chapter 9.