Editing Upper Urinary Tract Urothelial Cancer (section)

=====Adjuvant intravesical chemotherapy=====
*'''<span style="color:#ff0000">In patients undergoing RNU or SU (including distal ureterectomy) for UTUC, a single dose of perioperative intravesical chemotherapy should be administered in eligible patients to reduce the risk of bladder recurrence.[https://pubmed.ncbi.nlm.nih.gov/37096584/]</span>'''
**The exact timing of therapy has varied including instilling intravesical chemotherapy at the time of catheter removal (ODMIT-C trial), while other retrospective series reported instillation during surgery or up to 48 hours postoperatively.
***'''<span style="color:#ff00ff">ODMIT-C (2011)</span>'''
**** '''Population: 284 patients with no previous or concurrent history of bladder cancer undergoing nephroureterectomy for suspected UTUC'''
**** '''Randomized to a single postoperative intravesical dose of MMC''' (40 mg in 40 ml saline) '''at the time of urinary catheter removal''' '''vs. standard management'''
**** '''Results:'''
***** '''Risk of bladder tumour in first year reduced by 11%''' (27% MMC vs. 16% standard treatment)
**** [https://pubmed.ncbi.nlm.nih.gov/21684068/ O'Brien, Tim, et al.] "Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial)." European urology 60.4 (2011): 703-710.
*** Little data to support one intravesical chemotherapeutic over another.
****Many use gemcitabine over mitomycin due to risks of chemical peritonitis with extravesical extravasation of MMC