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

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Abstract
Objective To analyse the efficacy and safety of bacillus Calmette–Guérin (BCG) perfusion treatment forcarcinoma 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 efficacy 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 significant. 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.