[French ccAFU guidelines - update 2020-2022: upper urinary tract urothelial carcinoma]

Abstract

Introduction: -The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC).

Methods: - A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence.

Results: - The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease.

Conclusion: - These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.

Keywords: Bassinet; Cancer; Carcinome urothélial; Cytologie urinaire; Kidney; Rein; Renal pelvis; Survie; Survival; Ureter; Ureteroscopy; Uretère; Urinary cytology; Urothelial carcinoma; Urétéroscopie.