Adjuvant single-dose upper urinary tract instillation of mitomycin-C after therapeutic ureteroscopy for upper tract urothelial carcinoma: Preliminary results

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (MP50)1 Apr 2019MP50-04 ADJUVANT SINGLE-DOSE UPPER URINARY TRACT INSTILLATION OF MITOMYCIN C AFTER THERAPEUTIC URETEROSCOPY FOR UPPER TRACT UROTHELIAL CARCINOMA: PRELIMINARY RESULTS Andrea Gallioli*, Alberto Breda, Helena Vila-Reyes, Angelo Territo, Romain Boissier, Francesco Sanguedolce, Olga Mayordomo, Federica Regis, and Joan Palou Redorta Andrea Gallioli*Andrea Gallioli* More articles by this author , Alberto BredaAlberto Breda More articles by this author , Helena Vila-ReyesHelena Vila-Reyes More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Romain BoissierRomain Boissier More articles by this author , Francesco SanguedolceFrancesco Sanguedolce More articles by this author , Olga MayordomoOlga Mayordomo More articles by this author , Federica RegisFederica Regis More articles by this author , and Joan Palou RedortaJoan Palou Redorta More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556427.25550.4aAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Local or bladder recurrence is the main issue of endoscopic treatment for upper tract urothelial carcinoma (UTUC). Our aims are: I) to address safe and feasibility of adjuvant single-dose upper urinary tract instillation of mitomycin C (ASDM) after therapeutic ureteroscopy (URS), II) to compare ipsilateral (IRFS), bladder (BRFS), urothelial (URFS) recurrence-free survival of ASDM vs non-ASDM group. METHODS: From 04/2015 to 07/2018, 25 consecutive patients underwent ASDM within 24 hours after URS. A single-dose upper urinary tract instillation of 40 mg/ 40 ml mitomycin C diluted in 20 ml saline solution was administered in 1 hour, closing the bladder catheter. Clinical and perioperative data, 30-day complications (according to Clavien-Dindo scale) were collected. To compare ASDM vs control group (therapeutic URS without ASDM in the same period), patients with I) incomplete tumour ablation, II) indication for surgical management, III) induction upper tract instillations following URS were excluded. Follow-up provided II look URS after 3 months, following 6-month control with CT scan/URS. T-test and Fisher’s exact test were used to compare the groups. Kaplan Meier curve and Cox regression predicted IRFS, BRFS and URFS (i.e. ipsilateral or bladder tumour recurrence). RESULTS: ASDM was performed via nephrostomy (4%), single-J (80%) or double-J (16%). Clinical and perioperative data are listed in Table 1. ASDM (n=17) and control (n=14) group were comparable. No mitomycin-related adverse events were recorded. Self-limiting hematuria (16%), lumbar discomfort (16%), infection (8%) were the most frequent complications. Grade 3-4 (n=3) were: obstructive renal failure due to blood clots, re-intervention after concomitant bladder resection and heart failure requiring intensive care. Mean IRFS, BRFS and URFS were 22, 18 and 14.1 vs 26.4, 30.9 and 24.7 months for control and ASDM groups, respectively. Overall, ASDM reduced the 3.6 folds the risk of recurrence (95% IC; 0.86-15.8; p = 0.08). CONCLUSIONS: ASDM within 24 hours after therapeutic URS is safe and feasible and appears to reduce the risk of UTUC local recurrence. Although preliminary, these results encourage ASDM use after radical therapeutic URS. Source of Funding: None Barcelona, Spain© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e715-e715 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Gallioli* More articles by this author Alberto Breda More articles by this author Helena Vila-Reyes More articles by this author Angelo Territo More articles by this author Romain Boissier More articles by this author Francesco Sanguedolce More articles by this author Olga Mayordomo More articles by this author Federica Regis More articles by this author Joan Palou Redorta More articles by this author Expand All Advertisement PDF downloadLoading ...