Urothelial carcinoma of the upper urinary tract: current treatment strategies

Background The treatment spectrum of urothelial carcinoma of the upper urinary tract is broad and depends largely on the individual risk constellation. The diagnosis and diagnostics of spreading need to be as accurate as possible for the classification into the low-risk or high-risk group. Objective Presentation of new achievements in diagnostics and treatment options as well as the differentiated treatment strategies for localized urothelial carcinoma of the upper urinary tract. Material and methods A selective literature search was carried out in PubMed on the topic of urothelial carcinoma of the upper urinary tract, diagnostics, organ-preserving strategies, radical nephroureterectomy and multimodal treatment concepts. Results Advances in imaging and endoscopic techniques, in particular, have increased the diagnostic certainty and reduced understaging. An accurate stratification as possible into the low-risk or high-risk group simplifies clinical decision making. Kidney-preserving procedures, such as endoscopic laser-guided tumor ablation or ureteral segmental resection, can be used in certain constellations. Radical nephroureterectomy remains the gold standard for high-risk urothelial carcinoma of the upper urinary tract due to the high risk of progression and metastases. For clinical stage >= cT3 tumors an open approach is favored over a laparoscopic approach. Adjuvant platinum-based chemotherapy should be performed in a pathological tumor stage >= pT2 and/or pN+ following radical nephroureterectomy. Discussion New algorithms meanwhile provide the possibility to reduce treatment-induced morbidity and to improve the oncological outcome, particularly through more effective multimodal concepts.