Percutaneous Instillation of Chemolytic, Chemotherapeutic, and Antifungal Agents

Percutaneous therapy delivers medications directly into the collecting system, allowing high local concentrations while avoiding potential systemic complications. In this chapter, techniques of percutaneous instillation, and indications and side effects of chemolytic, chemotherapeutic, and antifungal agents are presented. In patients who are unfit for surgery, stone dissolution through chemolysis remains an option even with the advent of sophisticated endourologic technologies. It is most useful for cystine and struvite stones, and it is an option for uric acid stones when systemic medical therapy is not feasible. Unfortunately, there is no clinically useful irrigant for calcium oxalate calculi. Intracavitary immunotherapy/chemotherapy is a useful adjuvant therapy postendoscopic management of noninvasive upper tract transitional cell carcinoma with acceptable side effects. However, no individual study has shown significant difference in survival or recurrence. For patients with localized genitourinary fungal infections, percutaneous instillation of antifungal agents such as amphotericin B permits administration of highly toxic drugs, thereby minimizing systemic effects.