Disparity and dilemmas in the management of upper tract urothelial carcinoma

Upper tract urothelial carcinoma (UTUC) belong to the group of rare diseases. Due to the rarity of the disease, we lack high level evidence on different aspects of diagnostics and disease management. Despite this, two clinical practice guidelines exist with the aim of improving the quality of care and providing recommendations on diagnostics, treatment and follow-up based on the best available evidence. Patients with UTUC should be carefully evaluated to select those patients eligible for kidney sparing endoscopic treatment and identify patients at higher risk who are oncological better treated by radical surgery. Therefore, a fundamental part of the guidelines for UTUC is the introduction of the clinical risk stratification. Based on this risk classification, patients can be dichotomized into having low- or high-risk disease and forms the basis for definitive treatment selection for non-metastasized disease.
This dissertation critically examines the available diagnostics for UTUC, providing an extensive overview of real-world management practices gleaned from an international multicenter registry. Moreover, it addresses prevailing dilemmas and disparities by juxtaposing clinical practices against the recommendations outlined in existing guidelines. By scrutinizing diagnostic approaches, assessing real-world management practices, and identifying gaps between guidelines and clinical reality, this dissertation aims to contribute to the advancement of UTUC management strategies.