Editing AUA: Upper Tract Urothelial Carcinoma (2023) (section)

==== Adjuvant therapy ====

===== Pelvicalyceal or intravesical chemotherapy following ablation of UTUC tumors =====
*'''Considered optional''' 
*Principle of an immediate instillation of intravesical or pyelocaliceal (upper tract) chemotherapy at the time of endoscopic tumor ablation for UTUC is undertaken by extrapolation of the data supporting immediate instillation of intravesical chemotherapy at the time of transurethral resection of a bladder tumor
*Prior to administration, must confirm that there is no perforation of the bladder or upper tract
*Approaches
*#Antegrade perfusion by nephrostomy tube
*#Retrograde perfusion via ureteral catheter
*#Bladder instillation by transurethral catheter with reflux via a double J ureteral stent. 
*#*In the third scenario, a cystogram and demonstration of adequate reflux of contrast into the pyelocaliceal system is recommended.

===== Pelvicalyceal BCG =====
*'''May be offered to patients with HR favorable UTUC after complete tumor ablation or patients with upper tract carcinoma in situ (CIS).'''
*Consists of a 6-week induction course of BCG
*'''Imperative indications'''
*#'''Solitary kidney status'''
*#'''Bilateral UTUC'''
*#'''RIsk of progression to end-stage renal disease'''