Low-grade upper tract urothelial carcinoma (UTUC) comprises a substantial percentage of UTUCs. While mortality risk is low, diagnostic choices, therapeutic care, and continued management of these carcinomas are complex decisions. Low-grade UTUC can cause hematuria and urinary obstruction, and tumors tend to recur. Periodic radiographic imaging is required as well as ureteroscopic interventions not only to treat disease, but also to monitor for recurrence.