What are the EAU guidelines on the treatment of low-risk upper tract urothelial carcinomas?

Updated: Aug 07, 2020
  • Author: Kyle A Richards, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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According to European Association of Urology (EAU) guidelines, conservative management is appropriate for low-risk upper tract urothelial carcinomas.1 EAU indications of low risk are as follows:

  • Unifocal tumor

  • Tumor size < 1 cm

  • Low-grade tumor (cytology or biopsies)

  • No evidence of an infiltrative lesion on CT urography

  • Understanding of close follow-up

Treatment recommendations (all grade C) for these low-risk tumors are as follows1:

  • Laser should be used in endoscopic treatments

  • Flexible ureteroscopy is preferable to rigid ureteroscopy

  • A percutaneous approach can be used in small low-grade caliceal tumors unsuitable for ureteroscopic treatment; however, this approach is being used less frequently due to advances in equipment, including distal-tip deflection of ureteroscopes and laser technology39

  • Ureteroureterostomy is indicated for noninvasive low-grade tumors of the proximal ureter or midureter that cannot be removed completely via endoscopy

  • Complete distal ureterectomy and neocystostomy is indicated for noninvasive, low-grade tumors in the distal ureter that cannot be removed completely via endoscopy, and for high-grade, locally invasive tumors

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