title: Definitive tumor resection and percutaneous bacille Calmette-Guérin for management of renal pelvic transitional cell carcinoma in solitary kidneys.
abstract: OBJECTIVE
  This study was done to evaluate the safety and initial efficacy of definitive tumor resection combined with percutaneous bacille Calmette-Guérin (BCG) for management of renal pelvic transitional cell carcinoma (TCC) in patients with solitary kidneys.
  
  
  METHODS
  Eight patients with anatomically solitary kidneys, all of whom had a prior history of TCC elsewhere in the urinary tract, were treated with either partial nephrectomy (n = 2) or percutaneous resection (n = 6) combined with a 6-week course of topical BCG administered percutaneously. Seven (87.5%) of the 8 patients tolerated the complete BCG course without adverse effects. One patient required cessation of treatment for renal insufficiency, which resolved with discontinuation of therapy. Follow-up nephroscopy was performed 3 months after the initial tumor resection in 6 of the 8 patients, and all patients underwent regular follow-up surveillance at 3- to 6-month intervals thereafter with radiographic, cytologic, and, in some cases, ureteroscopic examinations.
  
  
  RESULTS
  With follow-up ranging from 9 to 59 (mean, 22) months, local tumor recurrence has become evident in only 1 patient. Two other patients have developed distant metastatic disease, both of whom had invasive TCC elsewhere in the urinary tract prior to treatment of the upper tract tumor.
  
  
  CONCLUSIONS
  Combining a 6-week course of percutaneously administered topical BCG with definitive tumor resection is generally well tolerated, and, ultimately, this protocol may result in a decreased incidence of local tumor recurrence in these high-risk patients.
authors.affiliation: Department of Urology, Cleveland Clinic Foundation, Ohio.
authors.forename: S P
authors.initials: SP
authors.lastname: Vasavada
authors.forename: S B
authors.initials: SB
authors.lastname: Streem
authors.forename: A C
authors.initials: AC
authors.lastname: Novick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D007680:Kidney Neoplasms / Q000601:surgery / Q000628:therapy*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D001500:BCG Vaccine