Challenges in Follow-up After Kidney-sparing Surgery for Upper Tract Urothelial Carcinoma: Insights from a Delphi Consensus

BACKGROUND AND OBJECTIVE: Kidney-sparing surgery (KSS) is the preferred treatment for patients with low-risk upper tract urothelial carcinoma (UTUC), offering a balance between oncologic efficacy and renal preservation. However, follow-up protocols are lacking due to insufficient evidence, resulting in clinical variability. In response, a Delphi consensus process has been initiated with the aim to refine and establish unified surveillance recommendations following KSS for low-risk UTUC. METHODS: A multistage Delphi consensus project was conducted by an expert panel, which completed four rounds of questionnaires using both open-ended and Likert scale-based questions, with the goal of achieving consensus on four key topics. KEY FINDINGS AND LIMITATIONS: In total, 28 invited experts participated in the Delphi panel, achieving consensus on the primary goals of UTUC follow-up, including tumour recurrence detection, renal function preservation, and maintaining quality of life. While consensus was reached on key diagnostic modalities (kidney function, computed tomography urography, cystoscopy, and ureteroscopy) and follow-up adjustments based on treatment indications, the precise schedules and long-term follow-up duration remained unresolved. CONCLUSIONS AND CLINICAL IMPLICATIONS: This Delphi project underscores the challenges of standardising follow-up protocols after KSS for UTUC. A balanced approach is needed to ensure early recurrence detection while preserving renal function and quality of life. Robust data on prognostic factors are essential to better identify patients at risk of recurrence and to refine surveillance strategies. Collaborative research remains essential for developing evidence-based follow-up protocols for this rare disease.