UTUC

Question 1

UTUC Epidemiology , Presentation, Pathology , Etiology, Eval ( Dx), Treatment

Answer 1

DEPPER Stepwise ( all in summary)

Question 2

What is the risk of Bladder recurrence after UTUC Rx

Answer 2

EAU = 29 %

Question 3

Risk of contralateral UTUC after Rx 6

Answer 3

2- 6%

Question 4

Risk Stratification of UTUC

Answer 4

Low risk UTUC
- LG cytology
- LG histology
- unifocal
- no invasion on CT
< 2cm

High risk UTUC
- HG cytology
- HG histo
- Local invasion
- Histological subtype
- multifocal
-> 2cm
- HUN

Question 5

TNM staging

Answer 5

Ta - non invasive papillary Uca
Tis - carcinoma insitu
T1 - Invades subepithelial connective tissue
T2 - Invades muscularis
T3 - Invades beyond the muscularis into the peripelvic fat or renal parenchyma ( ureter) tumour invades beyond muscularis into perinephric fat
T4 - Into adjacent organs or through the kidney into perinephric fat

N1 - Single LN < 2cm
N2 - Multiple LN or LN > 2cm

M1 - Distant mets

Question 7

What risk factors are different to bladder cancer

Answer 7

Balkan nephropathy
Lynch syndrome
Analgesic abuse - phenacetin

Question 8

Treatment for Low risk UTUC

Answer 8

NB! Pt must be able to follow up
- Ureteroscopy + laser ablation
- percutaneous acess and resection
- ureteral resection
- Chemo ablation - Mitomycin containing thermal gel ( UGN 101)

Question 9

Who gets adjuvant chemo for UTUC

Answer 9

LEVEL 1 evidence
POUT phase III prospective RCT
4 cycles of CG combo within 90 days post RNU vs AS
Disease free surveilance at 3 yrs 71 % vs 50%
5yrs 63% vs 46 %
MFS improvement = 19%

Indication = UTUC pT2-T4 N0M0 or any N1-2M0 , PS =0-1

Exclusion = GFR < 30 , Distant mets, unresectable, concurrent MIBC, PS >-2

Question 10

What aboutt NAC for UTUC

Answer 10

Neoadjuvant Chemotherapy for High-risk Localized Upper Tract Urothelial Carcinoma: Final Long-term Outcomes from a Phase 2 Clinical Trial and an Expanded Cohort

Aug 2025 _ European journal of urology

Pathologygical response rate of 63% in patients with high risk Utuc was treatedted with GC 4 cycles prior to definitive surgery and had RNU within 12 weeks after NAC

DFS and OS rates was similar to POUT at 5 yrs
But becase 60-85% of patients may be ineligibleible for adjuvant GC or even carbo -itcan be strongly recommendedmended

Question 11

Mitomycin Hydrogel = UGN 101

Answer 11

Reverse polymer hydrogel = thick at cold temperatures and gel at body temperature an dissolves in liquid
Thus developed as a sustained release mitomycin

Response rate of= 58 %
Side effects = Stricture rate 41 %

Stricture mitigation off label advice = Steroids and treatment holiday at first suggesition od any narrowing usually seen by 3rd or 4th Rx
Stenting
Give limited dose as adjuvant Rx after laser ablation
If giving all 6 doses for residual tumours = place a NT

Question 12

Survival outcomes of KSS vs RNU in Low risk disease

Answer 12

CSS and OS at 5-10 yrs has no significant difference