Presentation Authors: Andrea Gallioli*, Alberto Breda, Helena Vila-Reyes, Angelo Territo, Romain Boissier, Francesco Sanguedolce, Olga Mayordomo, Federica Regis, Joan Palou Redorta, Barcelona, Spain
Introduction: 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 Fisherâ€™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.