RESUMEN
Upper urinary tract urothelial carcinomas (UTUCs) are often identified and first treated endoscopically. After proper risk stratification, adjuvant treatment may be recommended. Consequently, as adjuvant therapy becomes more common place in the oncological armamentarium, we seek to better characterize its existing and future therapeutic landscape. In this article, we present an overview of the most up-to-date information about intracavitary instillations as an adjuvant therapy in the context of UTUC. We reviewed the current literature on the epidemiology, disease characteristics, treatment, and outcomes of UTUC with a particularly focus on intraluminal adjuvant therapy for UTUC. This review provides a comprehensive overview of the most recent available data regarding adjuvant therapies used for UTUC. Intraluminal therapy plays an increasingly important role in the management of UTUC. Mitomycin C is the most common adjuvant treatment for UTUC with bacillus Calmette-Guerin (BCG) being utilized to a lesser extent. UGN-101 is a novel topical gel-based therapy that has shown promising results and thus recently garnered Food and Drug Administration (FDA) approval for UTUC. Other treatments such as BCG-IFN, gemcitabine, docetaxel, and drug-eluting stents (DES) may play a future role in UTUC treatment given further research. It is important to caveat that current studies on topical adjuvant treatments demonstrate varying degrees of effectiveness. This is largely due to limited research on UTUC, consisting of small sample sizes, and mostly retrospective experiences. Accordingly, further clinical trials are needed to evaluate the true benefit of these treatments.
RESUMEN
COVID-19 has rapidly evolved into a global pandemic. In an attemp to reduce transmission, patients were advised to avoid in-person medical evaluations when possible. Accordingly, we hypothesize that fewer patients have sought care and undergone treatment for emergent urological conditions such as nephrolithiasis. We performed a retrospective chart review of patients undergoing emergent ureteral stent placement for obstructive nephrolithiasis from March 15, 2020 through May 31, 2020 and compared them to similar patients from a year earlier. We found that notably fewer patients underwent emergent stent placement during the COVID-19 era and that these patients were notably sicker. These findings suggest that indirect sequelae of the pandemic include delays in seeking care for conditions unrelated to the virus. Strategies such as increased use of in-office stenting and improved patient counseling may help reduce delays in care and improve clinical outcomes for patients with nephrolithiasis during subsequent peaks in the ongoing pandemic.
