Randomised level 1 data has shown that a single post-operative dose of intravesical chemotherapy reduces the risk of bladder tumour recurrence after neph-u.
ODMIT-C trial:
- Bladder recurrence in the first year 28 % in control arm vs 16 % in mitomycin C arm
Ito (2013)
- Single dose pirarubicin reduced bladder recurrence to 17 % at 2 years, vs 42 % in control arm
Strong recommendation in EAU guidelines for single dose intravesical chemotherapy to reduce bladder recurrence.
Logistics:
- Perform cystogram around day 7 through catheter
- If no leak, deliver 40 mg / 40 mL via catheter and leave to dwell for 2 hours prior to catheter removal
- Mitomycin C works better in alkalinised urine – therefore should probably start oral Sodibic the day prior
GEMINI trial is recruiting to assess intra-operative filling of bladder with gemcitabine during nephroureterectomy, with drainage prior to bladder cuff excision.