Endoscopic management offers acceptable oncologic control in select patients with upper tract urothelial carcinoma (UTUC) while preserving renal function. Adjuvant intracavitary treatment with chemotherapy or Bacillus Calmette-Guérin (BCG) has been proposed to reduce recurrence risk. We aimed to evaluate the impact of adjuvant intracavitary treatment on ipsilateral UTUC recurrence following endoscopic management.
We queried a multi-institutional cohort of patients who underwent endoscopic management for UTUC. Treatment groups were defined as no instillation, single post-operative instillation, or multiple instillations. Ipsilateral UTUC recurrence-free survival (RFS) was estimated using Kaplan-Meier curves and Cox proportional hazards models evaluated factors associated with recurrence.
A total of 599 renal units, of which 43 received single instillation and 86 multiple instillations, in 334 patients treated endoscopically for UTUC were analyzed. The median follow-up time for patients without recurrence was 12 months (IQR 4-33). Multiple adjuvant instillations of any intracavitary treatment were associated with a significantly improved RFS (HR 0.52, 95% CI 0.34-0.79), whereas a single instillation was not associated with a significant reduction in recurrence (HR 0.64, 95% CI 0.37-1.13). This association between multiple instillations and improved RFS remained significant after adjustment for clinical risk factors, including tumor grade (adjusted HR 0.36, 95% CI 0.16-0.81), and was confirmed in sensitivity analyses limited to patients with primary UTUC (HR 0.46, 95% CI 0.26-0.85).
Multiple intracavitary instillations of BCG or chemotherapy after endoscopic management of UTUC were associated with longer ipsilateral RFS. These findings suggest a potential benefit of repeated instillations and warrant prospective validation.
World journal of urology. 2026 May 19*** epublish ***
Philipp Korn, Maximilian Pallauf, Jaime O Herrera-Caceres, Soum Lokeshwar, Mark Essien, Alexander Small, Dima Raskolnikov, Nir Kleinmann, Asaf Shvero, Surena F Matin, Craig Labbate, Hristos Kaimakliotis, Isamu Tachibana, Jennifer Linehan, Jane Choe, Ojas Shah, Miyad Movassaghi, William Huang, Jesse Persily, Aaron Perecman, David Canes, Rodrigo R Pessoa, Aaron Potretzke, Jay D Raman, Nirmish Singla
Department of Urology and Oncology, The Brady Urological Institute at Johns Hopkins, Johns Hopkins School of Medicine, 600 N. Wolfe Street / Park 213, MD, 21287, Baltimore, USA., Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA., Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA., Department of Urology, Sheba Medical Center, Ramat Gan, Israel., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Indiana University Medical Center, Indianapolis, IN, USA., Department of Urology, Providence Specialty Medical Group, Santa Monica, CA, USA., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA., Department of Urology, New York University Grossman School of Medicine, New York, NY, USA., Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA., Department of Urology, Moffitt Cancer Center, Tampa, FL, USA., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology and Oncology, The Brady Urological Institute at Johns Hopkins, Johns Hopkins School of Medicine, 600 N. Wolfe Street / Park 213, MD, 21287, Baltimore, USA. .