Conservative Management of Upper Tract Urothelial Carcinoma: A Narrative Review

Upper tract urothelial carcinoma (UTUC) accounts for approximately 5–10% of urothelial malignancies and represents a clinically challenging disease due to its frequent presentation at advanced stages and its association with significant morbidity. Radical nephroureterectomy (RNU) with bladder cuff excision remains the standard treatment for high-risk disease; however, this approach inevitably results in loss of renal function and may significantly affect eligibility for cisplatin-based chemotherapy. In patients with imperative indications for renal preservation—including a solitary kidney, bilateral disease, or advanced chronic kidney disease—Kidney-Sparing Surgery (KSS) represents an essential therapeutic strategy. Technological advances in flexible ureteroscopy, improved visualization systems, and laser energy sources have significantly expanded the feasibility of conservative management. Ureteroscopic tumor ablation has become the cornerstone of KSS, allowing local disease control while preserving renal function. Although recurrence rates remain relatively high, repeated endoscopic treatment combined with strict surveillance protocols can achieve acceptable oncological outcomes in carefully selected patients. This narrative review summarizes the current evidence regarding conservative management of UTUC in imperative clinical situations, with particular emphasis on patient selection, endoscopic treatment modalities, laser technologies, economic implications, patient counselling, and follow-up strategies.