V08-09 Mitomycin-Containing Reverse Thermagel Ugn-101 for Upper Tract Urothelial Carcinoma: Retrograde Instillation in Clinic and Outcomes

You have accessJournal of UrologyBladder & Urothelial Upper Tract Oncology (V08)1 May 2024V08-09 MITOMYCIN-CONTAINING REVERSE THERMAGEL UGN-101 FOR UPPER TRACT UROTHELIAL CARCINOMA: RETROGRADE INSTILLATION IN CLINIC AND OUTCOMES Golena Fernandez Moncaleano, Nik B. Patel, Trudy Reicks, Russell E. N. Becker, Todd Morgan, Samuel Kaffenberger, Sapan Ambani, and Khurshid R. Ghani Golena Fernandez MoncaleanoGolena Fernandez Moncaleano , Nik B. PatelNik B. Patel , Trudy ReicksTrudy Reicks , Russell E. N. BeckerRussell E. N. Becker , Todd MorganTodd Morgan , Samuel KaffenbergerSamuel Kaffenberger , Sapan AmbaniSapan Ambani , and Khurshid R. GhaniKhurshid R. Ghani View All Author Informationhttps://doi.org/10.1097/01.JU.0001009440.59296.9f.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: UGN-101 was approved in 2020 for low-grade disease as adjuvant treatment provided as instillations into the kidney, for nephron preservation after endoscopic treatment. Treatment can be provided in the clinic using a retrograde approach, but the uptake is lower than antegrade instillation. There are concerns related to the risk of ureteral stenosis requiring stenting (49.3% - OLYMPUS trial). This video provides a step-by-step guide for UGN-101 retrograde instillation in clinic and informs on early outcomes from our center. METHODS: Following ureteroscopy and laser ablation, instillations with UGN-101 were performed in clinic under local anesthesia via flexible cystoscopy and a 7F custom designed ureteral catheter and injection gun. We reviewed (IRB approved) patients with low-grade disease undergoing UGN-101 between 01/2021-07/2023. Patients unable to tolerate a retrograde approach had antegrade instillation via nephrostomy. Induction of six-weekly instillation was provided followed by monthly maintenance if no adverse events and evidence of disease response. We assessed adverse events (AE) and cancer control outcomes. RESULTS: Steps for retrograde instillation include: 1) Flexible cystoscopy with guidewire access of ureter, 2) 7Fr ureteral catheter with molded Luer Lock port placement, 3) catheter visualization at the ureteropelvic junction through fluoroscopy, 4) Retrograde pyelogram to measure collecting system volume, 5) Withdrawal of UGN-101 into provided syringe, 6) Attachment to Uroject injection device 7) Syringe adaptor removal and connection to ureteral catheter 8) Slow injection with assessment of pain 9) Syringe and catheter removal.20 patients with a mean tumor burden of 1.67 cm (range 0.2-3.2), received at least one dose of UGN-101 of which 16 (80%) completed six instillations. 12 patients (60%) had a complete response (CR) after induction. 7 patients (35%) received at least one dose of monthly maintenance, of which 5 demonstrated durability of response. 6 patients (30%) had an AE related to the urinary system. Ureteral stents were placed in 5 patients for stenosis (25%); of which 4 were transient, with no subsequent obstruction. Only one patient (5%) required permanent stenting. CONCLUSIONS: UGN-101 instillation in clinic is easy to perform through a stepwise procedure. In this series, CR rates were similar to OLYMPUS trial. However, ureteral stenosis requiring stenting was lower than previously reported. Future research is needed to determine local factors contributing to these results at our center. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e559 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Golena Fernandez Moncaleano More articles by this author Nik B. Patel More articles by this author Trudy Reicks More articles by this author Russell E. N. Becker More articles by this author Todd Morgan More articles by this author Samuel Kaffenberger More articles by this author Sapan Ambani More articles by this author Khurshid R. Ghani More articles by this author Expand All Advertisement PDF downloadLoading ...