Conservative management of low-risk utuc

Conservative management of upper tract urothelial cancer (UTUC) treats tumor, prevents disease progression, lowers potential morbidity, and avoids unnecessary loss of renal function by avoiding nephroureterectomy. Limitations associated with conservative therapies include the potential for undetected disease progression. Patients with UTUC are more difficult to stage clinically than in bladder cancer. Endoscopic management can be performed ureteroscopically or percutaneously. Ideal indications include a unifocal tumor, small tumor size, and low-grade disease. A positive selective cytology suggests the presence of higher grade disease and potentially more advanced pathological T stage. Endoscopic technique is critical both for accurate diagnostic purposes and for safe performance of the procedure. The results of endoscopic therapy are highly dependent on tumor factors, with lowgrade tumors having much better results than high-grade tumors. The use of adjuvant topical therapy after complete endoscopic tumor control remains unclear. The strongest role for topical therapy for UTUC is for CIS, when it is used as primary therapy. The use of segmental or distal ureterectomy and partial nephrectomy for UTUC has narrow indications with the latter needing to be applied extremely selectively. Nephroureterectomy remains the gold standard treatment, but comes at the cost of significant loss of renal function. Single-dose treatment of the bladder after nephroureterectomy is considered a new standard of care, and could be considered an option by extension of this logic, to single-dose treatment after endoscopic therapy of the upper tracts.