Upper tract urothelial carcinoma (UTUC) is a rare malignancy with an incidence of 1 case per 50,000 people in developed countries. Because symptoms are often non-specific, there are delays in presentation and diagnosis and, as a result, more than half of patients present with muscle-invasive or locally advanced disease. The gold standard treatment for localized UTUC has been radical nephroureterectomy followed by surveillance.1 However, as with bladder urothelial carcinoma, UTUC has a range of primary tumor aggressiveness, ranging from relatively indolent, superficial low-grade disease to the aforementioned locally invasive disease. Thus, not all patients may require nephroureterectomy. Further, due to renal dysfunction or other medical comorbidities, patients may not be fit for radical surgery.