Endoscopic Management of Upper Tract UC and the Role of Mitomycin

Cayce Nawaf, MD, discusses the relationship between mitomycin and endoscopic management of upper tract urothelial carcinoma (UC). Dr. Nawaf begins with a quick overview of upper tract UC, noting that it is relatively rare.

Dr. Nawaf then compares the outcomes of endoscopic management against those of nephroureterectomy. He illustrates the 5- and 10- year oncologic outcomes from both treatments, demonstrating the similarities between grade groups and presenting the AUA guidelines as additional support.

Dr. Nawaf addresses concerns regarding agent delivery methods to the kidney, and presents examples of nephrostomy tubes, double pigtail stents, and ureteral catheters. He presents data from the OLYMPUS Trial supporting the efficacy of retrograde delivery via ureteral catheter.

Regarding agents, Dr. Nawaf presents data on the efficacy of mitomycin While 58.8-61% of patients had a complete response to the treatment, he notes that there are moderate to severe side effects and caveats around endoscopic management of upper tract UC with mitomycin.

He concludes with a step-by-step guide to using mitomycin in treatment. Dr. Nawaf underscores the importance of selecting patients correctly for treatment based on disease grade and patient preference.

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