Bacillus Calmette–Guérin instillation treatment for carcinoma in situ of the upper urinary tract

Abstract

Objective To analyse the ef®cacy and safety of bacillus Calmette±Gue Ârin (BCG) perfusion treatment for carcinoma in situ (CIS) of the upper urinary tract. Patients and methods Six patients with cytologically diagnosed CIS of the upper urinary tract were treated by BCG instillation via retrograde catheterization using a 6 F ureteric catheter or an 8 F indwelling JJ ureteric stent between the ureter and bladder. BCG (Tokyo 172 strain, 80 mg in 100 mL normal saline) was instilled weekly for 4 or 8 weeks. The ef®cacy and safety of the treatment was assessed. Results The mean (range) follow-up was 22 (9± 38) months; none of the patients died, and all were negative for cytology in urine collected from the upper urinary tracts. However, one patient had recurrent CIS in the prostatic urethra; the patient was treated by intravesical BCG instillation. In all patients, positive cytology became negative after one or two instillations of BCG. The ureter became stenotic in two patients. Although irritative symptoms occurred in all patients, such side-effects disappeared in a few months and were not clinically signi®cant. Conclusion In these six patients retrograde BCG instillation for CIS of the upper urinary tract was effective and safe. Based on the cytology results after only two BCG treatments, the dose or number of BCG instillations could possibly be reduced, but further study is needed.

Clinical outcome of bacillus Calmette‐Guérin perfusion therapy for carcinoma in situ of the upper urinary tract

“…Recently, we have tended to select a retrograde ureteric catheterization using the Double-J stent, because this method makes it possible to administer BCG without hospitalization. In addition, consistent with previous studies, 4,[8][9][10][11][12][13][14] the present results suggest that the efficacy of this method may be similar to others, if VUR was S-J + D-J 100 9-38 Okubo et al 12 …”

“…One of the primary concerns for intrarenal BCG therapy is choosing when to convert to surgical treatment in cases of recurrence. In eight previously reported studies of intrarenal BCG therapy for CIS of the upper urinary tract, 4,[8][9][10][11][12][13][14] 75 renal units were treated according to the same criteria used in the present study, and 20 of the 75 units (27%) showed no response either recurrence. In 20 of these patients, 7 underwent surgical treatment, whereas radiologically documented invasive tumors developed in 9 of the remaining 13 patients.…”

“…Previous studies have reported several advantages and disadvantages in each method. [9][10][11] For example, percutaneous BCG instillation is the most reliable method of perfusion of BCG in the renal pelvis; 4 however, it is relatively invasive, and can possibly cause the implantation of cancer cells along the nephrostomy tract. Recently, we have tended to select a retrograde ureteric catheterization using the Double-J stent, because this method makes it possible to administer BCG without hospitalization.…”

“…2 However, only a few studies have analyzed the efficacy of BCG therapy for CIS of the upper urinary tract. [3][4][5][6][7][8][9][10][11][12] Therefore, several points need to be elucidated, especially the most appropriate therapeutic strategy in patients with a poor response or recurrence of CIS after intrarenal BCG therapy. Therefore, in the present study, we retrospectively reviewed our experience of BCG instillation for patients with CIS of the upper urinary tract, and evaluated its efficacy and safety.…”

Intracavitary Therapy of Noninvasive Transitional Cell Carcinomas of the Upper Urinary Tract

“…Due to the appealing results, BCG intracavitary therapy gained interest and was then used as prophylaxis by some authors in pilot trials [19,20,[33][34][35][36] after anterograde or retrograde endourological treatment of papillary tumors or as therapy for residual disease [2, 32,34,35,[37][38][39][40], particularly carcinoma in situ [37][38][39][40][41].…”