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, 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 in the era of sophisticated endourologic technologies. Percutaneous chemolysis is most useful for cystine and struvite stones. Percutaneous chemolysis is also an option for uric acid stones when systemic medical therapy is not feasible in patients who are noncompliant or cannot tolerate oral chemolytic agents. Unfortunately, there is no clinically useful irrigant for dissolving calcium oxalate calculi. Intracavitary immunotherapy/chemotherapy is a useful adjuvant therapy post‐endoscopic 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 topical antifungal agents such as amphotericin B permits administration of highly toxic antifungal drugs, thereby minimizing systemic side‐effects.