A Case of Complete Remission of Bilateral Upper Tract Carcinoma In Situ Following Retrograde Bacillus Calmette-Guérin (BCG) Instillation via Open-Ended Ureteral Catheters After Failure Using Double-J Stents.

INTRODUCTION

We present a case of carcinoma in situ (CIS) of the bilateral upper urinary tract (UUT) in which long-term complete remission was achieved through retrograde perfusion of Bacillus Calmette-Guérin (BCG) via open-ended ureteral catheters following the failure of endoluminal therapy using double-J stents.

CASE PRESENTATION: A 52-year-old male patient was diagnosed with CIS of the bilateral UUT and bladder. Intravesical BCG instillation using double-J stents failed to eradicate persistently positive catheter urine cytology from the bilateral UUT. Since the patient strongly desired kidney-sparing treatment, retrograde BCG perfusion via open-ended ureteral catheter was performed. This treatment resulted in durable complete remission lasting 3 years.

CONCLUSIONS

Retrograde BCG treatment via double-J stent may result in suboptimal efficacy due to limited drug exposure to the UUT urothelium. In cases in which kidney-sparing treatment is required, retrograde BCG perfusion via open-ended ureteral catheters may be considered a viable therapeutic option.