Upper Urinary Tract Urothelial Cell Carcinoma

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 2021 print:

  • Chapter 5 – Diagnosis, new section 5.3 – 18F-Fluorodeoxglucose positron emission tomography/computed tomography (FDT-PET/CT) was added resulting in a change of a recommendation.

5.7 Summary of evidence and guidelines for the diagnosis of UTUC

RecommendationStrength rating
Magnetic resonance urography or FDG-PET/CT may be used when CT is contraindicated.Weak


  • Chapter 6 – Prognosis, additional information has been addeded and this section was restructured, resulting in changes to Figures 6.1 and 6.2 and the Summary of evidence. New sections 6.2.2 – Perioperative predictive tools for high risk disease and 6.3 – Bladder recurrence were added.

6.4 Summary of evidence and guidelines for the prognosis of UTUC

Summary of evidenceLE
Models are available to predict non-organ confined disease and altered prognosis after RNU.3
Patient, tumour and treatment-related factors impact risk of bladder recurrence.3


  • Chapter 7 – Treatment, Sections 7.1.2 – Management of high-risk non-metastatic UTUC and – Induction chemotherapy were added. Section 7.1.5 – Post-operative bladder instillation was expanded, resulting in a changed recommendation.

7.1.6 Summary of evidence and guidelines for the management of high-risk non-metastatic UTUC 

Summary of evidenceLE
Post-operative chemotherapy improves disease-free survival.1b


RecommendationStrength rating
Offer post-operative systemic platinum-based chemotherapy to patients with muscle-invasive UTUC.Strong


  • Section 7.2 – Metastatic disease, systemic treatments, considerable new data has been added in both the first-line and second-line setting, not resulting in a change to the recommendations. A change was made to Figure 7.2 – Surgical treatment according to location and status, to include post-operative chemotherapy as an option for high-risk tumours.