Intrarenal Bacillus Calmette-Guerin Therapy for Upper Urinary Tract Carcinoma in Situ

Abstract

Of 17 renal units from 11 patients treated with intrarenal bacillus Calmette-Guerin (BCG) for positive selective upper tract urine cytology 16 had negative radiographic studies and 1 had a papillary renal pelvic lesion. The standard diagnostic maneuvers were used to rule out other sources of positive cytology from the lower tracts. Six patients had bilateral involvement, 3 had prior contralateral nephroureterectomy and 2 had unilateral positive cytology but were poor surgical risks. The BCG solution was administered weekly by retrograde ureteral catheterization and instillation during 1 hour. One patient had fever during the initial treatment and received antituberculous therapy. Other side effects included transient hematuria in 3 patients and irritative urinary symptoms in most patients. Of 11 patients (12 renal units) 8 had normalization of the urinary cytology with a median followup of 36 months. One patient had unilateral conversion of the cytology result but the contralateral papillary tumor persisted, requiring nephroureterectomy. The remaining 2 patients had persistently positive cytology results and the disease progressed. Longer followup and further experience with intrarenal BCG are required before the exact role of this treatment modality in upper tract urothelial malignancies, including carcinoma in situ, can be determined.

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.…”

“…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.…”

Bacillus Calmette–Guérin Perfusion Therapy for the Treatment of Transitional Cell Carcinoma in situ of the Upper Urinary Tract

“…Laser ablation using ureteroscopy is also on choice of the treatment for those imperative cases [19, 20, 21]. Nevertheless, nephroureterectomy is still considered the standard treatment for upper urinary tract TCC [13]. Morales et al [1, 4]demonstrated the efficacy of BCG instillation into the bladder as prophylaxis against superficial bladder cancer and in treatment against CIS of the bladder.…”

“…This therapy has already become an important part of the management of noninvasive TCC of the urinary bladder [1, 2, 3, 4, 5, 6, 7]. However, there are only a few reports on the use of BCG therapy for TCC including CIS of the upper urinary tract [8, 9, 10, 11, 12, 13, 14]. From a recent viewpoint of minimally invasive therapy, BCG therapy can also be applied to CIS in the upper urinary tract.…”