(UroToday.com) The 2021 American Urological Association (AUA) Summer School session on Upper Tract Urothelial Carcinoma included a case-based discussion led by moderator Dr. Surena Matin who was joined by panelists Dr. Sima Porten and Dr. Vitaly Margulis. This case discussed high-risk ureteral urothelial carcinoma within the setting of node-positive disease. The patient was a 49-year-old male with a 1.5-year history of cT1HG plus CIS bladder cancer treated with TURBT, BCG induction, and maintenance therapy. He subsequently developed right flank pain and a CT scan showed new right hydronephrosis read by radiology as inflammation and recommendation for follow-up imaging. A CT scan 2 months later showed right hydronephrosis with a distal ureteral mass and a 2 cm interaortocaval lymph node. A biopsy of the lymph node confirmed poorly differentiated carcinoma and ureteroscopy confirmed a sessile tumor in the distal ureter (cT2) with no tumors above the ureteral lesion, no obvious bladder tumors, and no obvious metastatic disease. eGFR was 74 and a mutation panel from the biopsy showed FGFR3 and TP53 mutations: