Complications of Intracavitary Bacillus Calmette-Guerin After Percutaneous Resection of Upper Tract Transitional Cell Carcinoma

Bellman, Gary C.; Sweetser, Philip M.; Smith, Arthur D.

doi:10.1016/s0022-5347(17)34860-7

Cited by 60 publications

(16 citation statements)

References 15 publications

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“…Such measures minimize major complications such as sepsis; although granulomatous changes in the kidney and systemic adverse effects relating to bacillus Calmette-Guerin (BCG) infection can occur. 48,49 The same agents used to treat urothelial carcinoma of the bladder can be used to treat tumors RaMan anD sCHERR aUGUst 2007 vOL 4 nO 8 www.nature.com/clinicalpractice/uro r e v i e w of the upper tracts. The most common agents instilled are BCG or mitomycin-C. Orihuela and colleagues noted that patients treated with BCG via a nephrostomy tube had a significantly lower recurrence rate than patients who did not receive BCG (16.6% vs 80%, respectively).…”

Section: Adjuvant Topical Therapymentioning

confidence: 99%

Management of patients with upper urinary tract transitional cell carcinoma

2007

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Multiple therapeutic options are available for the management of patients with upper urinary tract transitional cell carcinoma (TCC). Radical nephroureterectomy with an ipsilateral bladder cuff is the gold-standard therapy for upper-tract cancers. However, less invasive alternatives have a role in the treatment of this disease. Endoscopic management of upper-tract TCC is a reasonable strategy for patients with anatomic or functional solitary kidneys, bilateral upper-tract TCC, baseline renal insufficiency, and significant comorbid diseases. Select patients with a normal contralateral kidney who have small, low-grade lesions might also be candidates for endoscopic ablation. Distal ureterectomy is an option for patients with high-grade, invasive, or bulky tumors of the distal ureter not amenable to endoscopic management. In appropriately selected patients, outcomes following distal ureterectomy are similar to that of radical nephroureterectomy. Bladder cancer is a common occurrence following the management of upper-tract TCC. Currently, there are no variables that consistently predict which patients will develop intravesical recurrences. As such, surveillance with cystoscopy and cytology following surgical management of upper-tract TCC is essential. Extrapolating from data on bladder TCC, both regional lymphadenectomy and neoadjuvant chemotherapy regimens are likely to be beneficial for patients with upper-tract TCC, particularly in the setting of bulky disease.

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Section: Adjuvant Topical Therapymentioning

confidence: 99%

Management of patients with upper urinary tract transitional cell carcinoma

2007

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“…[15][16][17][18] It is interesting to note that renal granulomas postintra-renal installation of BCG has been reported at a much higher rate of 25% when compared with intravesical installation (0.1%). 3,19 The fact that both of these patients developed renal granulomas may support the use of intravesical BCG for management of upper tract urothelial carcinoma.…”

Section: Discussionmentioning

confidence: 88%

BCG-Related Renal Granulomas Managed Conservatively

Al‐Qaoud¹,

Brimo²,

Aprikian³

et al. 2015

CUAJ

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Introduction: The aim of this case series is to present two cases of renal granulomas discovered incidentally post-intravesical Bacillus Calmette-Guerin (BCG) installations and were managed conservatively. Case reports: The first case is a 68-year-old man with bladder and right ureteral orifice carcinoma in situ. After transurethral resection of the right ureteral orifice and bladder tumours, he received 6 + 3 weekly intravesical installations of BCG and then 6 + 3 weekly intravesical installations of BCG with interferon alpha (IFN) in the presence of an indwelling ureteral stent since he had refused cystoprostatectomy. At the 18-month follow-up, his computed tomography scan showed two right renal masses. Biopsy demonstrated non-necrotizing granulomatosis. Serial follow-up with imaging studies showed complete resolution of these masses without antituberculous medications. The second case is a 74-year old man with left renal high-grade papillary urothelial carcinoma. After ureteral meatotomy and insertion of indwelling ureteral stents, he received 6 weekly intravesical installations of BCG followed by 3 weekly installations of BCG and IFN prior to the definitive management with laparoscopic left nephroureterectomy. Final pathology showed pT1 urothelial carcinoma and an incidental finding of BCG-related renal granulamotosis. The patient has been asymptomatic and did not require anti-tuberculous medications. Conclusions: While these two cases demonstrate the ability of intravesical BCG to reach the renal pelvis, patients with a history of intravesical BCG with incidental renal masses may benefit from renal biopsy. These renal granulomas may resolve without antituberculous medications.

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“…Although irritative symptoms occurred in some patients, such side effects disappeared spontaneously within a few hours and were not clinically significant [46]. One patient had massive macrohematuria requiring multiple transfusions [33].…”

Section: Side Effectsmentioning

confidence: 96%