Intrarenal bacillus Calmette-Guérin therapy for carcinoma in situ of the upper urinary tract: Long-term follow-up and natural course in cases of failure

K. Okubo, K. Ichioka, N. Terada, Y. Matsuta, K. Yoshimura, Y. Arai

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42 Citations (Scopus)

Abstract

Objective: To assess the long-term efficacy of intrarenal bacillus Calmette-Guérin (BCG) therapy for the treatment of cytologically diagnosed upper tract carcinoma in situ (CIS) and report the time course in cases of failure. Patients and methods: Fourteen renal units in 11 patients cytologically diagnosed as having upper urinary tract (UUT) CIS were treated with intrarenal BCG instillation. The BCG solution was administered by retrograde ureteric catheterization weekly for 6 weeks. Results: Seven units were radiologically and cytologically free of disease at a median follow-up of 60 months. Two units which showed an initial response had recurrence with ipsilateral UUT CIS. The remaining five units did not respond to BCG. Of seven units with an initial negativeresponse or recurrent UUT CIS, nephroureterectomy was undertaken in one because of coincidental renal cell carcinoma. In four of the remaining six units, invasive pelvic tumour developed at a mean follow-up of 20.5 months after the final instillation. Computed tomography showed wall thickening of the renal pelvis in two and mass-forming tumour in the renal parenchyma mimicking renal cell carcinoma in two. In three of these four cases, retrograde pyelography did not show typical findings of renal pelvic tumour, e.g. filling defect, infundibular obstruction or stenosis. Conclusions: Intrarenal BCG is effective in the treatment of UUT CIS in a long-term follow-up. In cases with a poor response or ipsilateral recurrence of CIS, there is a high risk of developing invasive tumour. Close follow-up using computed tomography is recommended because of the atypical radiographic findings of such tumours.

Original languageEnglish
Pages (from-to)343-347
Number of pages5
JournalBJU International
Volume88
Issue number4
DOIs
Publication statusPublished - 2001

Keywords

  • BCG
  • Bacillus Calmette-Gúerin
  • Carcinoma in situ
  • Intrarenal instillation
  • Natural course
  • Upper urinary tract

ASJC Scopus subject areas

  • Urology

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