Bacillus Calmette‐Guérin perfusion therapy for carcinoma in situ of the upper urinary tract

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Abstract
Objective To analyse the clinical and therapeutic consequences of bacillus Calmette‐Guérin (BCG) perfusion therapy for carcinoma in situ (CIS) of the upper urinary tract. Patients and methods Eight pyelo‐ureteric systems in five patients with cytologically confirmed CIS of the upper urinary tract were treated using perfusion of BCG through a percutaneous nephrostomy tube in five and a retrograde ureteric catheter in three. Follow‐up cystoscopy, retrograde pyelography and selective urinary cytology were obtained 4 weeks after the last treatment and every 3 months thereafter. Results In three patients (five pyelo‐ureteric systems) the cytology remained negative for 10–46 months after the treatment was completed. The remaining two patients (three pyelo‐ureteric systems) had persistently positive cytology. Of two patients who received BCG therapy through a ureteric catheter, one developed a ureteric stricture and the other developed renal tuberculosis. Conclusions Although long‐term adaptation to a nephrostomy tube disturbs the quality of life of the patient, percutaneous perfusion therapy through a nephrostomy tube seems to be safer than retrograde perfusion through a ureteric catheter.

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