BCG-instillations for upper tract urothelial carcinoma after radical cystectomy: a single center experience

BACKGROUND: High-risk UTUC typically necessitates radical nephroureterectomy (RNU), though renal-sparing options are needed due to contraindications such as severe chronic kidney disease. Bacillus Calmette-Guérin (BCG) instillations in the upper urinary tract (UUT) have emerged as a potential kidney-sparing treatment. The use of such treatment in UTUC for patients who previously underwent radical cystectomy (RC) with ileal diversion has not been investigated to date.METHODS: This retrospective study analyzed a cohort from a single tertiary referral center involving UTUC patients who had previously undergone RC with ileal conduit. Patients with carcinoma in situ (CIS) detected in the UUT post-RC received six weekly BCG instillations. We evaluated safety and efficacy of BCG-instillations in this patient population. Efficacy was defined in terms of recurrences during the follow-up.RESULTS: A total of 7 patients with a median age of 70 years received BCG-instillations in the UUT for UTUC. Most patients had unilateral UTUC. Complications related to BCG instillations were registered in two patients, both in the form of urinary tract infections. Over a median follow-up of 49 months, the complete response rate was 43%. UTUC recurrence in the ipsilateral UUT happened in 4 out of 7 patients. One patient died due to metastatic urothelial carcinoma. The main limitations include the study’s small sample size, retrospective nature, and single-center scope, which may introduce selection bias and limit the generalizability of findings.CONCLUSIONS: BCG instillation in the UUT for UTUC patients post-RC is feasible and presents a viable renal-sparing alternative. However, the high recurrence rate underscores the need for ongoing surveillance and possibly adjunctive treatments.