Conservative management of upper tract urothelial carcinoma

Upper tract urothelial carcinoma (UTUC) represents a unique subset of urothelial cancers characterized by tumors located in the renal pelvis and ureter. Accounting for 5-10% of all urothelial cancers, UTUC often requires radical treatment due to its potential for rapid progression and poor prognosis. While radical nephroureterectomy with bladder cuff excision remains the standard treatment for high-risk cases, conservative management strategies are increasingly recognized for their benefits in preserving renal function without compromising oncological outcomes in low-risk patients. This narrative review synthesizes current evidence on the diagnosis, risk classification, and follow-up of UTUC, focusing on the implementation of conservative management practices. Advanced diagnostic tools, including multiphase computed tomography urography and ureterorenoscopy, play pivotal roles in accurate disease staging, while molecular markers and risk stratification facilitate tailored diagnostic and treatment approaches. Ongoing research and future innovations aim to refine these strategies, enhancing patient selection and treatment efficacy.