2. METHODS
2.1. Data identification
For the 2025 UTUC Guidelines, new and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature. The search was restricted to articles published between May 1st 2023 and May 1st 2024. Databases searched included Pubmed, Ovid, EMBASE and both the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. After deduplication, a total of 302 unique records were identified, retrieved, and screened for relevance.
Excluded from the search were basic research studies, case series, reports, and editorial comments. The publications identified were mainly retrospective, including some large multicentre studies. Owing to the scarcity of randomised data, articles were selected based on the following criteria: evolution of concepts, intermediate- and long-term clinical outcomes, study quality, and relevance. Older studies were only included if they were historically relevant.
The publications identified were mainly retrospective, including some large multicentre studies. Owing to the paucity of randomised data, articles were selected based on the following criteria: evolution of concepts, intermediate- and long-term clinical outcomes, study quality, and relevance. Older studies were only included if they were historically relevant. A detailed search strategy is available online: https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/publications-appendices.
Recommendations within the Guidelines are developed by the panels to prioritise clinically important care decisions. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and the nature and variability of patient values and preferences. This decision process, which can be reviewed in the strength rating forms which accompany each guideline statement, addresses a number of key elements:
- the overall quality of the evidence which exists for the recommendation [5];
- the magnitude of the effect (individual or combined effects);
- the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
- the balance between desirable and undesirable outcomes;
- the impact and certainty of patient values and preferences on the intervention.
Strong recommendations typically indicate a high degree of evidence quality and / or a favourable balance of benefit to harm and patient preference. Weak recommendations typically indicate availability of lower quality evidence, and/or equivocal balance between benefit and harm, and uncertainty or variability of patient preference [6].
Additional methodology information and a list of associations endorsing the EAU Guidelines can be found online: https://uroweb.org/eau-guidelines/methodology-policies.
2.2. Review
The UTUC Guidelines were subject to peer-review prior to publication in 2023.