Hypotonic Fluids versus Chemotherapy Wash for the Prevention of Bladder Cancer in Patients with Upper Tract Urothelial Cancer

Inclusion Criteria

• Biopsy proven upper tract urothelial carcinoma (UTUC) with plan for excisional surgery (distal ureterectomy or nephroureterectomy) with curative intent.
• Age 18 - 90 years.
• Life expectancy > 1 year.
• Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
• A female of childbearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: * Has not undergone a hysterectomy or bilateral oophorectomy; or * Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).
• Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria

• Concurrent or prior diagnosis of bladder cancer with a disease-free interval of less than three years.
• Synchronous bilateral upper tract urothelial carcinoma (prior history of contralateral upper tract urothelial carcinoma [UTUC] is permissible with a disease-free interval of more than three years).
• Plan for radical cystectomy.
• Small bladder capacity (< 100 mL).
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to gemcitabine or other agents used in study.