title: Upper urinary tract instillations in the treatment of urothelial carcinomas: a review of technical constraints and outcomes.
abstract: OBJECTIVE
  The role of topical upper urinary tract instillation as adjuvant treatment after conservative management of urothelial carcinomas remains unclear. The aim of this article was to review available techniques and protocols proposed to treat urothelial carcinomas of the upper tract (UTUC).
  
  
  METHODS
  Evidence acquisition on UTUC topical instillations was performed by a Medline search using combinations of the following key words: urothelial carcinomas; upper urinary tract; renal pelvis; ureter; adjuvant therapy; recurrence; bacillus Calmette-Guérin (BCG); mitomycin C. A total of 36 publications were included in analysis.
  
  
  RESULTS
  Different approaches have been reported for instillation of the upper tract (UT): percutaneous nephrostomy, retrograde catheterisation and vesico-ureteral reflux. Currently, BCG and mitomycin C are the most commonly agents used for topical treatment of UTUC. A role for BCG in the management of UT carcinoma in situ (CIS) has been demonstrated in retrospective studies, although a definitive efficacy of adjuvant topical therapy after endoscopic resection of Ta/T1 tumours has not yet been proven. No individual study has shown a statistical improvement in survival and recurrence rates.
  
  
  CONCLUSIONS
  Currently BCG instillation should be considered as first-line treatment for UT CIS managed conservatively in carefully selected patients. The place for adjuvant topical instillation after ablation of Ta/T1 tumours is less evident and should be evaluated on an individual basis.
authors.affiliation: Academic Department of Urology of Georges Pompidou European Hospital (HEGP), Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Descartes, University Paris V, Paris, France. francois.audenet@gmail.com
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000287:Administration, Topical; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002278:Carcinoma in Situ / Q000188:drug therapy*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D007682:Kidney Pelvis; D009403:Nephrostomy, Percutaneous; D014516:Ureteral Neoplasms / Q000188:drug therapy*; D014546:Urinary Catheterization
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents