Upper tract urothelial carcinoma (UTUC) is a relatively rare malignant tumor in the urinary system, characterized by a latent onset, strong invasiveness, and high recurrence rate. Radical nephroureterectomy has been the standard treatment for this condition for several decades, effectively preventing tumor recurrence or distant metastasis. However, for elderly patients, solitary kidneys, bilateral tumors, and those with renal insufficiency, postoperative renal function significantly declines, limiting the application of platinum-based chemotherapy. In recent years, with the development of imaging diagnosis, endoscopic techniques, and robotic surgery, nephron-sparing treatment has shown promising application prospects in specific patient groups. This article reviews the research progress of nephron-sparing treatment for UTUC based on updated international guidelines and the latest clinical research evidence.