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Mitomycin Gel for the Pyelocaliceal System in Patients With Urinary Diversion: First Reported Cases and Operative

Kai Wen Cheng1, Grant Sajdak2, Ala A Farkouh1

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Mitomycin gel (UGN-101) shows promise for kidney-sparing treatment of upper tract urothelial carcinoma (UTUC) in patients with prior urinary diversion. Antegrade instillation techniques were successfully adapted, with patients remaining disease-free post-treatment.

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Area of Science:

  • Urology
  • Oncology
  • Nephrology

Background:

  • Upper tract urothelial carcinoma (UTUC) treatment often involves nephroureterectomy, but kidney-sparing options are sought for select patients.
  • Mitomycin gel for the pyelocaliceal system (UGN-101) is an approved therapy for UTUC, but its use in patients with urinary diversion is not well-documented.
  • Urinary diversion, often resulting from radical cystectomy, presents unique anatomical challenges for intravesical therapies.

Purpose of the Study:

  • To evaluate the safety and efficacy of UGN-101 instillation in patients with UTUC and a history of urinary diversion.
  • To describe techniques for overcoming anatomical challenges associated with UGN-101 delivery in this patient population.
  • To report the clinical outcomes, including complications and disease status, following UGN-101 treatment.

Main Methods:

  • Retrospective review of patients with UTUC and pre-existing urinary diversion who received UGN-101 instillation.
  • Detailed description of surgical techniques employed for antegrade UGN-101 instillation via nephrostomy tube or catheter.
  • Monitoring of clinical course, including infectious complications, ureteral strictures, and diversion-related issues.

Main Results:

  • Two patients with UTUC and urinary diversion were treated with UGN-101 via antegrade instillation.
  • Both patients experienced infectious complications; one developed a ureteral stricture that resolved spontaneously.
  • No diversion-related complications were observed, and both patients achieved disease-free status at 10-month follow-up, with one requiring additional immunotherapy.

Conclusions:

  • UGN-101 instillation is a viable kidney-sparing option for UTUC in patients with prior urinary diversion.
  • Antegrade instillation can be customized to disease location, offering a treatment alternative for those unsuitable for surgery.
  • Further investigation is warranted to confirm the long-term safety and efficacy of UGN-101 in this complex patient group.