Elsevier

European Urology

Volume 66, Issue 2, August 2014, Pages 181-183
European Urology

Platinum Opinion
A New Proposal to Risk Stratify Urothelial Carcinomas of the Upper Urinary Tract (UTUCs) in a Predefinitive Treatment Setting: Low-risk Versus High-risk UTUCs

https://doi.org/10.1016/j.eururo.2013.12.007Get rights and content

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Conflicts of interest

The authors have nothing to disclose.

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    Preoperative staging of UUT-UC is difficult. In order not to fail to recognise locally advanced disease or disease with a high risk of progression, a risk group classification is proposed mainly to select the best candidates for conservative treatment [58,59] (level of evidence: 4) (Table 2): Low-risk UUT-UC (all criteria present): low biopsy grade, negative urine cytology for high grade (Paris 2022), non-invasive appearance on imaging, unifocal disease, tumour size < 2 cm, possibility of complete conservative treatment.

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    Although the risk of tumor extravasation and dissemination with URS is low, there are some studies showing that it may be associated with an increase in bladder recurrences, so it should be used only in patients with doubtful diagnosis or when organ-preservation strategies are being considered.141–143 Kidney-sparing approaches can be offered to patients with low-risk UTUC, including tumors with all the following characteristics: unifocal disease, tumor size less than 2 cm, low-grade cytology, low-grade URS biopsy, and noninvasive appearance on imaging.144,145 In these patients, survival is comparable with radical treatment, irrespective of the function of the opposite kidney.146

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