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.