title: Intravesical instillation of bacille Calmette-Guérin for carcinoma in situ of the urothelium involving the upper urinary tract using vesicoureteral reflux created by a double-pigtail catheter.
abstract: OBJECTIVE
  To evaluate the therapeutic efficacy of bacille Calmette-Guérin (BCG) for carcinoma in situ (CIS) of the urothelium involving the upper urinary tract when the vaccine was administered by way of the bladder using vesicoureteral reflux created by a double-pigtail (DP) catheter.
  
  
  METHODS
  Thirteen upper urinary tracts of 9 patients with cytologically diagnosed CIS, with concomitant bladder CIS in 4, were treated by intravesical BCG instillation. A DP catheter was placed retrogradely, and the appearance of vesicoureteral reflux was confirmed by cystography. BCG (1 to 2 mg/mL) in a volume sufficient to fill the renal caliceal system was administered into the bladder weekly for 6 weeks. The mean follow-up was 36 months (range 8 to 97).
  
  
  RESULTS
  The voided urine cytology turned negative in all 9 patients at a mean of 86 days after the first administration of BCG. The voided urine cytology returned positive afterward in 3 patients, and positive cytology in the upper urinary tract was confirmed in 1 of 13 treated urinary tracts, which were successfully treated by another course of BCG therapy with the DP catheter. Minor adverse effects related to BCG and the DP catheter were seen in 5 patients.
  
  
  CONCLUSIONS
  BCG therapy for the CIS involving the upper urinary tract using a DP catheter might have the potential to be an effective procedure preserving renal units and could be adopted not only as an imperative, but also as an elective, treatment option.
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Irie
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kadowaki
authors.forename: Asako
authors.initials: A
authors.lastname: Ohkawa
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Uchida
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
mesh_terms: D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage*; D002278:Carcinoma in Situ / Q000473:pathology / Q000628:therapy*; D006801:Humans; D014516:Ureteral Neoplasms / Q000473:pathology / Q000628:therapy*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*; D014556:Urine / Q000166:cytology
chemical_list: D001500:BCG Vaccine