Transient anuria requiring nephrostomy after intravesical bacillus Calmette-Guérin instillations for superficial bladder cancer.
A 76-year-old man received intravesical bacillus Calmette-Guérin (BCG) instillations for recurrent superficial bladder cancer. He had undergone right nephroureterectomy for right renal pelvic cancer 9 months previously. He presented with anuria and left hydronephrosis after the fourth instillation, with serum creatinine increasing up to 15.7 mg/dL. Percutaneous nephrostomy was indwelled, and antegrade pyelography showed left vesicoureteral obstruction. There was no sign of recurrent bladder cancer or ureteral cancer. He started spontaneous voiding on day 4 and the nephrostomy was removed on day 8. Most of the side-effects of intravesical BCG therapy are minor, and major adverse reactions are rare. Life-threatening ureteral obstruction would be a rare complication of BCG immunotherapy. Although BCG intravesical instillation after nephroureterectomy is a common practice, special care should be taken of renal function in patients with unilateral kidney during BCG therapy.
Kaneko
Tomoyuki
T
Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan. minerva@muc.biglobe.ne.jp
Fujita
Kiichiro
K
Homma
Yukio
Y
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects*; D000283:Administration, Intravesical; D000368:Aged; D001002:Anuria / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000188:drug therapy*; D003558:Cystoscopy; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy; D009403:Nephrostomy, Percutaneous; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D014567:Urography
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine