The efficacy of Bacillus Calmette-Guerin instillation therapy of the upper urinary tract for carcinoma in situ

Background. Treatment of carcinoma in situ (CIS) of the upper urinary tract is still difficult. In this study, we assessed the efficacy and safety results of Bacillus Calmette-Guerin (BCG) instillation therapy for CIS of the upper urinary tract. Methods. Thirteen renal units with CIS in eight patients 6077 years old (median, 68 years) were treated with BCG. BCG (Tokyo 172 strain) was instilled at a dose of 160mg into each renal unit once a week for 6 consecutive weeks via nephrostomy. The follow-up period ranged from 7 to 63 months (median, 26 months). Results. Of 13 renal units in eight patients, 12 units (92.3%) in eight patients became negative by cytology. Only 1 renal unit showed recurrence. The duration of the response ranged from 7 to 63 months (median, 25 months). Few side effects were observed after BCG instillation. Fever was most frequent (6/8, 75%), followed by symptoms of irritation such as frequency (5/8, 62.5%). Conclusion. BCG instillation therapy is safe and effective for CIS of the upper urinary tract. It can be used as a first-line therapy instead of any surgical option.