AUA: Upper Tract Urothelial Carcinoma (2023): Difference between revisions
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**'''<span style="color:#ff0000">Initial management for LR favorable UTUC, when technically feasible</span>''' | **'''<span style="color:#ff0000">Initial management for LR favorable UTUC, when technically feasible</span>''' | ||
***Observational studies suggest similar cancer-specific survival, similar complication rates, and improved renal function outcomes with endoscopic ablation, compared to nephroureterectomy | ***Observational studies suggest similar cancer-specific survival, similar complication rates, and improved renal function outcomes with endoscopic ablation, compared to nephroureterectomy | ||
* '''<span style="color:#ff0000">Optional</span>''' | * '''<span style="color:#ff0000">Optional</span>''' | ||
**'''<span style="color:#ff0000">Initial management for LR unfavorable UTUC and select patients with HR favorable disease who have low-volume tumors or cannot undergo RNU</span>''' | **'''<span style="color:#ff0000">Initial management for LR unfavorable UTUC and select patients with HR favorable disease who have low-volume tumors or cannot undergo RNU</span>''' | ||
*'''<span style="color:#ff0000">If low-risk and complete endoscopic ablation not feasible, chemoablation (in-situ tissue destruction) with mitomycin containing reverse thermal gel can be a treatment alternative</span>''' | |||
**High risk of ureteric stenosis with instillation of mitomycin containing reverse thermal gel | |||
=== Technical considerations === | === Technical considerations === | ||
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=== Adjuvant therapy === | === Adjuvant therapy === | ||
==== Pelvicalyceal or intravesical chemotherapy ==== | ==== Pelvicalyceal or intravesical chemotherapy following ablation of UTUC tumors ==== | ||
*'''Considered | *'''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 | *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 | *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 ==== | ==== Pelvicalyceal BCG ==== | ||
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*Consists of a 6-week induction course of BCG | *Consists of a 6-week induction course of BCG | ||
*'''Imperative indications''' | *'''Imperative indications''' | ||
* | *#'''Solitary kidney status''' | ||
* | *#'''Bilateral UTUC''' | ||
* | *#'''RIsk of progression to end-stage renal disease''' | ||
=== Repeat endoscopic evaluation === | === Repeat endoscopic evaluation === | ||