Mitomycin Gel for the Pyelocaliceal System in Patients With Urinary Diversion: First Reported Cases and Operative Technique.

Purpose: Mitomycin gel for the pyelocaliceal system (UGN-101) is an approved kidney-sparing therapy for upper tract urothelial carcinoma (UTUC). Little to no data exist on its safety and efficacy in patients with a history of urinary diversion. We report our experience with overcoming the anatomical challenges of UGN-101 instillation in patients with UTUC and prior history of radical cystectomy with urinary diversion. Materials and Methods: Retrospective review was performed on all patients with pre-existing urinary diversion who underwent UGN-101 instillation for management of UTUC at a single academic institution. Surgical techniques for instillation are described, and the clinical course, including complications and disease status, are reported. Results: Two patients met inclusion criteria. One patient had carcinoma in situ in the renal pelvis and was treated with antegrade instillation via nephrostomy tube at an infusion clinic. The second patient had multifocal disease in the renal pelvis and the distal ureter and was treated with targeted antegrade instillation using an end-hole catheter. Both patients experienced infectious complications, and one had a ureteral stricture that resolved without intervention. No diversion-related complications were observed. Both patients are disease-free at last follow-up (10 months) on endoscopy and biopsy, although one patient required systemic immunotherapy. Conclusions: Our series highlights the potential role of UGN-101 in patients with UTUC and pre-existing urinary diversion. Antegrade instillation of UGN-101 can be tailored to specific disease locations and should be considered for patients with a history of urinary diversion who are not candidates for extirpative surgery.