Antegrade administration of mitomycin gel for upper tract urothelial carcinoma via percutaneous nephrostomy tube: a multi‐institutional retrospective cohort study

Abstract

To assess the safety profile of antegrade mitomycin gel instillation through a percutaneous nephrostomy tube (PCNT) for upper tract urothelial carcinoma (UTUC) with the aim of decreasing morbidity associated with therapy. Patients and MethodsPatients undergoing antegrade administration of mitomycin gel via PCNT were retrospectively included for analysis from four tertiary referral centres between 2020 and 2022. The primary outcome was safety profile, as graded by Common Terminology Criteria for Adverse Events (v5.0). Post-therapy disease burden was assessed by primary disease evaluation (PDE) via ureteroscopy. ResultsThirty-two patients received at least one dose of mitomycin gel via PCNT for UTUC, 29 of whom completed induction and underwent PDE. Thirteen patients (41%) had residual tumour present prior to induction therapy. At a median of 15.0 months following first dose of induction therapy, ureteric stenosis occurred in three patients (9%), all of whom were treated without later recurrence or chronic stenosis. Other adverse events included fatigue (27%), flank pain (19%), urinary tract infection (12%), sepsis (8%) and haematuria (8%). No patients had impaired renal function during follow-up and there were no treatment-related deaths. Seventeen patients (59%) had no evidence of disease at PDE and have not experienced recurrence at a median follow-up of 13.0 months post induction. ConclusionsAdministration of mitomycin gel via a PCNT offers a low rate of ureteric stenosis, demonstrates a favourable safety profile, and is administered without general anaesthesia.

The Utility of Intraluminal Therapies in Upper Tract Urothelial Carcinoma: A Narrative Review

“…Rose et al administered Mitomycin gel via percutaneous nephrostomy to 32 patients over the course of 2 years, with only 9% (3/32) suffering from a stricture following induction therapy, compared to the 29% (12/41) stricture rate in the OLYMPUS study in patients who only received induction therapy. The low rates in Rose et al's study suggest that the strictures in the OLYMPUS trial may have been due to repeated ureteric procedures rather than the drug itself [31].…”

New technologies for nephron-sparing surgery in upper urinary tract cancers

“…Seventeen patients (59%) were free of disease at a median follow-up of 13 months post instillations. Remarkably, ureteral stenosis was observed in only nine (9%) patients [30]. Recently, the results of UGN-101 upper tract instillation as adjuvant treatment after complete endoscopic ablation have been reported.…”