Intravesical Therapy for Upper Urinary Tract Urothelial Carcinoma: A Comprehensive Review

SIMPLE SUMMARY: This comprehensive review discusses the current status and future prospects of intravesical therapy for upper urinary tract urothelial carcinoma (UTUC). It emphasizes the need to understand its role in UTUC management and the importance of personalized strategies for drug selection, dosage, timing and frequency to optimize treatment outcomes and reduce intravesical recurrence. By summarizing historical development, clinical trials, guideline recommendations, and clinical applications, this review provides valuable insights. We aim to guide future studies and impact the research in UTUC, advancing the understanding and utilization of intravesical therapy for UTUC. ABSTRACT: Upper tract urothelial carcinoma (UTUC) poses unique challenges in diagnosis and treatment. This comprehensive review focuses on prophylactic intravesical therapy for UTUC, summarizing key aspects of intravesical therapy in various clinical scenarios, including concurrent with or following radical nephroureterectomy, kidney-sparing surgery, ureteroscopy-guided biopsy. The incidence of intravesical recurrence in UTUC after surgical treatment is significant, necessitating effective preventive measures. Intravesical therapy plays a vital role in reducing the risk of bladder recurrence following UTUC surgery. Tailoring timing, drug selection, dosage, and frequency is vital in optimizing treatment outcomes and reducing intravesical recurrence risk in UTUC. This review provides a comprehensive summary of the history, clinical trials, guideline recommendations, and clinical applications of intravesical therapy for UTUC. It also discusses the future directions based on current clinical needs and ongoing trials. Future directions entail optimizing dosage, treatment duration, and drug selection, as well as exploring novel agents and combination therapies. Intravesical therapy holds tremendous potential in improving outcomes for UTUC patients and reducing the risk of bladder recurrence. Although advancements have been made in UTUC treatment research, further refinements are necessary to enhance efficacy and safety.