Methotrexate elimination in a patient with an orthotopic neobladder with and without a urethral catheter.
Placement of a urethral catheter has been recommended to ensure adequate methotrexate elimination in patients with a neobladder; however, the need for this and its impact on methotrexate elimination have not been determined. A 53-year-old man with a cecal continent urinary diversion received intravenous methotrexate 30 mg/m2 on two occasions, with and without urethral catheter drainage of the neobladder. Serum methotrexate concentrations declined at a rate that resulted in 24- and 48-hour values falling below the accepted toxic concentration threshold of 5-50 mumol/L, and 0.05 mumol/L, respectively. In this man, who received low-dose methotrexate, catheterization of the neobladder did not alter methotrexate elimination sufficiently to justify its cost, risk, and inconvenience.
Dorothea Dix Hospital, Raleigh, North Carolina, USA.
P D
PD
Wire
R E
RE
Dupuis
J L
JL
Mohler
S A
SA
Bernard
C M
CM
Lindley
D000964:Antimetabolites, Antineoplastic / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008727:Methotrexate / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy; D014546:Urinary Catheterization; D016476:Urinary Reservoirs, Continent
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate