Intrarenal bacillus Calmette-Guerin therapy for carcinoma in situ of the upper urinary tract

(Purpose) We performed intrarenal bacillus Calmette-Guerin (BCG) instillation for carcinoma in situ (CIS) of the upper urinary tract. Its efficacy and safety are evaluated. (Material and Methods) Eight patients (6 men and 2 women, median age of 63.7 years) diagnosed as upper urinary tract carcinoma in situ were studied. One had bilateral upper urinary tract CIS. Thus, 9 units of upper urinary tract were treated with BCG instillation. Diagnostic criteria of upper urinary tract CIS were: (1) positive voided urinary cytology, (2) negative multiple random biopsy of the bladder and the prostatic urethra, (3) negative radiographic studies, (4) two serial positive cytologies in selective ipsilateral urine sampling. The BCG solution was administered weekly by retrograde ureteral catheterization under local anesthesia and instillation during one hour. Second course instillation was performed when 1st course was not effective. (Results) Of 9 renal units 7 (78%) had normalization of the urinary cytology at the end of the 1st course BCG therapy. One patient with CIS of the bilateral upper tract had negative cytology of the unilateral unit, and underwent the contralateral nephroureterectomy because of persistent positive urinary cytology and coincidental renal cell carcinoma. One patient did not have negative cytology even after three courses of BCG instillation and is now under observation. During the procedure, high fever and bladder irritative symptom were observed in 6 out of the 8 patients (75%) and 4 (50%), respectively. (Conclusions) Although longer followup and further experience with intrarenal BCG are required, this treatment is considered to be effective and safe for upper tract CIS.