Intravesical chemotherapy use after radical nephroureterectomy: A national survey of urologic oncologists

To determine the use of prophylactic intravesical chemotherapy (pIVC) following radical nephroureterectomy (RNU) and barriers to utilization in a survey study of urologic oncologists. Methods A survey instrument was constructed, which queried respondents on professional experience, practice environment, pIVC use, and reasons for not recommending pIVC when applicable. The survey was electronically distributed to members of the Society of Urologic Oncology over an 8-week period. Survey software was used for analysis. Results The survey response rate was 22% (158 of 722). Half of the respondents were in practice for ≤10 years, while 90% performed ≤10 RNU cases annually. Of the 144 urologists regularly performing RNU, only 51% reported administering pIVC, including 22 exclusively in patients with a prior history of bladder cancer. One-third administered pIVC intraoperatively, whereas the remainder instilled pIVC at ≤3 (7%), 4 to 7 (37%), 8 to 14 (20%), and>14 (3%) days postoperatively. Almost all urologists noted giving a single instillation of pIVC. Agents included mitomycin-C (88%), thiotepa (7%), doxorubicin (3%), epirubicin (1%), and BCG (1%). Among respondents who did not administer pIVC, the most common reasons cited included lack of data supporting use (44%), personal preference (19%), and office infrastructure (17%). Conclusion Only 51% of urologic oncologists report using pIVC in patients undergoing RNU. Reasons underlying this underutilization are multifactorial, thereby underscoring the need for continued dissemination of existing data and additional studies to support its benefits. Moreover, improving the logistics of pIVC administration may help to increase utilization rates.