title: Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma.
abstract: BACKGROUND
  The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases (ICUD) publication on UTUC stratified treatment allocations based on high- and low-risk groups. This report updates the conservative management of the low-risk group.
  
  
  METHODS
  The ICUD for low-risk UTUC working group performed a thorough review of the literature with an assessment of the level of evidence and grade of recommendation for a variety of published studies in this disease space. We update these publications and provide a summary of that original report.
  
  
  RESULTS
  There are no prospective randomized controlled studies to support surgical management guidelines. A risk-stratified approach based on clinical, endoscopic, and biopsy assessment allows selection of patients who could benefit from kidney-preserving procedures with oncological outcomes potentially similar to radical nephroureterectomy with bladder cuff excision, with the added benefit of renal function preservation. These treatments are aided by the development of high-definition flexible digital URS, multi-biopsies with the aid of access sheaths and other tools, and promising developments in the use of adjuvant topical therapy.
  
  
  CONCLUSIONS
  Recent developments in imaging, minimally invasive techniques, multimodality approaches, and adjuvant topical regimens and bladder cancer prevention raise the hope for improved risk stratification and may greatly improve the endoscopic treatment for low-risk UTUC.
authors.affiliation: , Houston, TX, USA.
authors.forename: Rao S
authors.initials: RS
authors.lastname: Mandalapu
authors.affiliation: LKH Korneuburg, Korneuburg, Austria.
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.affiliation: AMC University Hospital, Amsterdam, The Netherlands.
authors.forename: Theo M
authors.initials: TM
authors.lastname: de Reijke
authors.affiliation: Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.affiliation: Fundacio Puigvert, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Palou
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Yossepowitch
authors.affiliation: Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Coleman
authors.affiliation: Hôpital Tenon, Université Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
authors.affiliation: University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: J Kyle
authors.initials: JK
authors.lastname: Anderson
authors.affiliation: Academic Urology Unit, University of Sheffield, Sheffield, UK.
authors.forename: James
authors.initials: J
authors.lastname: Catto
authors.affiliation: AMC University Hospital, Amsterdam, The Netherlands.
authors.forename: Jean
authors.initials: J
authors.lastname: de la Rosette
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: O'Brien
authors.affiliation: Mt. Sinai Hospital, Toronto, ON, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Zlotta
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA. surmatin@mdanderson.org.
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
mesh_terms: D000283:Administration, Intravesical; D000287:Administration, Topical; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003558:Cystoscopy; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy; D009403:Nephrostomy, Percutaneous; D059351:Organ Sparing Treatments; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012955:Societies, Medical; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy; D013520:Urologic Surgical Procedures; D014572:Urology
chemical_list: D000970:Antineoplastic Agents
keywords: Calyces; Nephroureterectomy; Renal pelvis; Upper tract; Ureteroscopy; Urothelial cancer