AUA: Upper Tract Urothelial Carcinoma (2023): Difference between revisions

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 **#Means of fluid egress from the upper tract to avoid excess pelvicalyceal hydrostatic pressure from irrigation solutions
 **#Lower rate of intravesical recurrence (based on observational study)
-'''Adjuvant therapy'''
-* '''Pelvicalyceal or intravesical chemotherapy'''
+=== Adjuvant therapy ===
-**'''Considered an optional part of routine practice''' following ablation of UTUC tumors and after confirming there is no perforation of the bladder or upper tract
-**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
+==== Pelvicalyceal or intravesical chemotherapy ====
-**Approaches
+*'''Considered an optional part of routine practice''' following ablation of UTUC tumors and after confirming there is no perforation of the bladder or upper tract
-***Antegrade perfusion by nephrostomy tube
+*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
-***Retrograde perfusion via ureteral catheter,
+*Approaches
-***Bladder instillation by transurethral catheter with reflux via a double J ureteral stent.
+**Antegrade perfusion by nephrostomy tube
-****In the third scenario, it is recommended to perform a cystogram and demonstrate adequate reflux of contrast into the pyelocaliceal system.
+**Retrograde perfusion via ureteral catheter,
-**'''Pelvicalyceal BCG'''
+**Bladder instillation by transurethral catheter with reflux via a double J ureteral stent.
-***'''May be offered to patients with HR favorable UTUC after complete tumor ablation or patients with upper tract carcinoma in situ (CIS).'''
+***In the third scenario, it is recommended to perform a cystogram and demonstrate adequate reflux of contrast into the pyelocaliceal system.
-***Consists of a 6-week induction course of BCG
-***'''Imperative indications'''
+==== Pelvicalyceal BCG ====
-****'''Solitary kidney status'''
+*'''May be offered to patients with HR favorable UTUC after complete tumor ablation or patients with upper tract carcinoma in situ (CIS).'''
-****'''Bilateral UTUC'''
+*Consists of a 6-week induction course of BCG
-****'''RIsk of progression to end-stage renal disease'''
+*'''Imperative indications'''
-'''Repeat endoscopic evaluation'''
+**'''Solitary kidney status'''
+**'''Bilateral UTUC'''
+**'''RIsk of progression to end-stage renal disease'''
+=== Repeat endoscopic evaluation ===
 *Proclivity of UTUC to recur and for residual disease to remain after the first ablation
 *'''Should be performed within three months'''