Preface to “newer techniques and tools lead to a paradigm shift in the diagnosis and management of upper tract urothelial carcinoma”
Research on upper tract urothelial carcinoma (UTUC) has become a point of emphasis in the uro-oncologic community as of late. Over the past several decades, surgical and medical innovation has transformed the diagnosis and treatment of UTUC. In fact, survival rates have increased thanks to myriad of reasons including (I) technological advances in surgical technique, (II) focus on nephron sparing-surgery where applicable, and (III) multi-disciplinary management by using chemotherapy in the neoadjuvant or adjuvant setting. Despite the low incidence and prevalence of this disease, data from recent high-quality publications and randomized clinical trials has rapidly transformed clinical practice. This special series of terrific and well-written review articles authored by some of the leaders and experts in the field captures the many advancements and innovations in UTUC.
Newer advances in ureteroscopy, specifically from fiber-optic to digital ureteroscopes, has led to earlier and more seamless detection of upper tract tumors allowing high quality biopsies. The European Association of Urology (EAU) and American Urological Association (AUA) have updated guidelines based on the latest evidence-based medicine. Advances in cross sectional imaging along with cytological and histopathological diagnosis help in proper risk-stratification, which is critical when considering treatment options. Speaking of treatments, advances in drug development as well as surgical innovation has allowed the possibility of nephron-sparing surgery. Where once cancer in the upper tract demanded removal the entire healthy kidney and ureter, newer techniques of distal ureterectomy, segmental ureterectomy, and ileal interposition has preserved renal function and limited the development of chronic kidney disease. Chemoablation of the upper tract using UGN-101 in select patients has emerged as a therapeutic alternative to nephroureterectomy for select indications. Moreover, the development of novel laser therapies such as holmium/yttrium-aluminum-garnet (YAG), neodymium/YAG, and thulium/YAG has also resulted in ability to preserve renal function. Additional topics found in this series are technique based with a step-by-step overview of robotic nephroureterectomy (considered as the gold standard) and a separate article on how to best tackle the distal ureter and bladder cuff—thought to be the most technically challenging part of the surgery. With the robotic approach becoming more en vogue, one topic explores the role, if any, of open surgery in the management of UTUC. Regardless of approach, sound oncologic principles should be followed when managing patients with UTUC. Three separate review articles explore the oncologic outcomes following radical nephroureterectomy including the role of adjuvant/neoadjuvant chemotherapy and timing/evidence of intravesical therapy at the time of surgery.
Editing this series has led us to take a step back and marvel upon the remarkable growth of evidence-based research and practice-changing guidelines in the field of UTUC. Review of these high-yield topics can help our readers achieve a thorough understanding of this rare but impactful cancer. Despite advances in management of upper tract urothelial cancer over three decades, work is still in progress to help our patients. We are excited to see how artificial intelligence can transform the uro-oncology space by predicting prognostic patterns, confirming variant histologies using digital pathologies, and predict treatment survival based on preoperative characteristics. Obtaining an accurate diagnosis ureteroscopically can be challenging and perhaps computed tomography (CT) urogram findings coupled with patient-specific patterns can help predict likelihood of high-risk malignancy. A more personalized and patient-centered treatment plan may be achieved using specific molecular footprints that are yet to be discovered. We are excited to learn of the future directions in UTUC diagnosis and management. Finally, the editors of this series are eternally grateful to all the contributors in providing best evidence-based approach in the management of such cancer.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Translational Andrology and Urology, for the series “Upper Tract Urothelial Cancer”. The article did not undergo external peer review.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-356/coif). The series “Upper Tract Urothelial Cancer” was commissioned by the editorial office without any funding or sponsorship. R.A.P. and A.K.H. served as the unpaid Guest Editors of the series. A.K.H. serves as an unpaid editorial board member of Translational Andrology and Urology from November 2019 to October 2025. The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
