title: Retrograde chemoinfusion of the upper tract: standardizing the delivery of topical adjuvant therapy.
abstract: Upper tract urothelial carcinoma has a high recurrence rate after endoscopic treatment. Immediate postoperative topical chemotherapy may reduce recurrences, as in bladder cancer. A reliable delivery method to the upper tract does not exist. We propose a new infusion pump technology for the delivery of topical chemotherapeutic agents to the upper tract. With the patient under general anesthesia, contrast is infused into the upper collecting system using a standard infusion pump. An optimal infusion rate is determined based on fluoroscopic filling of the upper collecting system and transduced intrapelvic pressures. Using this rate, the infusion is repeated postoperatively with the chemotherapeutic agent. We report one case of successful execution to demonstrate proof of concept. We are the first to describe retrograde upper tract chemotherapeutic irrigation with an intravenous pump. This technique may facilitate and standardize the delivery of intracavitary chemotherapy. Further investigation to determine whether it translates into improved safety and/or efficacy is warranted.
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Maurice
authors.forename: Rabii
authors.initials: R
authors.lastname: Madi
authors.forename: Debby Y
authors.initials: DY
authors.lastname: Chuang
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
mesh_terms: D000287:Administration, Topical; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000592:standards; D006801:Humans; D007260:Infusion Pumps; D036502:Infusions, Intralesional / Q000379:methods / Q000592:standards; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008297:Male
chemical_list: D000970:Antineoplastic Agents