BACILLUS-CALMETTE-GUERIN PERFUSION THERAPY FOR CARCINOMA IN-SITU OF THE UPPER URINARY-TRACT

Objective To analyse the clinical and therapeutic consequences of baci llus Calmette-Guerin (BCG) perfusion therapy for carcinoma in situ (CI S) of the upper urinary tract. Patients and methods Eight pyelo-ureter ic systems in five patients with cytologically confirmed CIS of the up per urinary tract were treated using perfusion of BCG through a percut aneous nephrostomy tube in five and a retrograde ureteric catheter in three. Followup cystoscopy, retrograde pyelography and selective urina ry cytology were obtained 4 weeks after the last treatment and every 3 months thereafter. Results In three patients (five pyelo-ureteric sys tems) the cytology remained negative for 10-46 months after the treatm ent was completed. The remaining two patients (three pyelo-ureteric sy stems) had persistently positive cytology, Of two patients who receive d BCG therapy through a ureteric catheter, one developed a ureteric st ructure and the other developed renal tuberculosis. Conclusions Althou gh long-term adaptation to a nephrostomy tube disturbs the quality of life of the patient, percutaneous perfusion therapy through a nephrost omy tube seems to be safer than retrograde perfusion through a ureteri c catheter.