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Journal article
Evaluating the Safety of Intraoperative Instillation of Intravesical Chemotherapy at the Time of Nephroureterectomy
BMC Urology, Vol.15, 45 (2015)
05/28/2015
DOI: 10.1186/s12894-015-0039-0
PMCID: PMC4446833
PMID: 26018765
Abstract
<p><h4>Background</h4></p>
<p>Urothelial carcinoma (UC) is a common cancer affecting many patients in the United States. Nephroureterectomy remains the gold standard for the treatment of high grade upper tract disease or low grade tumors that are not amenable to endoscopic management. Recent reports have shown a decrease in UC recurrence in patients who underwent nephroureterectomy and who had Mitomycin C (MMC) instilled into the bladder at the time of catheter removal. At our institution instillation of intravesical MMC at the time of nephroureterectomy has been common for more than 10 years. Given the recent data, we sought to formally describe our experience with and evaluate the safety of intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy. <h4>Methods</h4></p>
<p>We retrospectively reviewed 51 patients who underwent intraoperative intravesical instillation of cytotoxic chemotherapy (MMC (<em>n</em> = 48) or adriamycin (<em>n</em> = 3)) at the time of nephroureterectomy (2000–2012). The procedure was performed in a similar fashion by 8 different surgeons from the same institution, with drainage of the bladder prior to management of the bladder cuff. Patient characteristics and perioperative data including complications out to 90 days after surgery were collected. Perioperative complications for all patients were graded using the modified Clavien-Dindo classification. <h4>Results</h4></p>
<p>Twenty-four men and 27 women underwent intraoperative intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy. Median age at the time of operation was 74 years (range 48–88). Median dwell time was 60 min. Twenty three patients had a total of 45 perioperative complications. The majority (36/45) were Clavien grades I and II. No patients experienced any intraoperative or postoperative complications attributable to MMC or Adriamycin instillation. <h4>Conclusion</h4></p>
<p>Intraoperative intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy is safe and feasible. Multicenter trials to study the efficacy of early cytotoxic chemotherapy administration to prevent recurrence of bladder urothelial carcinoma following nephroureterectomy are warranted.</p>
Details
- Title: Subtitle
- Evaluating the Safety of Intraoperative Instillation of Intravesical Chemotherapy at the Time of Nephroureterectomy
- Creators
- Michael A Moriarty - University of IowaMatthew A Uhlman - University of IowaMegan T Bing - University of IowaMichael A O'Donnell - University of IowaJames A Brown - University of IowaChad R Tracy - University of IowaSundeep Deorah - University of IowaKenneth G Nepple - University of IowaAmit Gupta - University of Iowa
- Resource Type
- Journal article
- Publication Details
- BMC Urology, Vol.15, 45 (2015)
- DOI
- 10.1186/s12894-015-0039-0
- PMID
- 26018765
- PMCID
- PMC4446833
- ISSN
- 1471-2490
- Copyright
- © 2015 Moriarty et al.
- Language
- English
- Date published
- 05/28/2015
- Academic Unit
- Urology; Carver College of Medicine
- Record Identifier
- 9983557343302771
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