Definitive tumor resection and percutaneous bacille Calmette-Guérin for management of renal pelvic transitional cell carcinoma in solitary kidneys.

OBJECTIVES

This study was done to evaluate the safety and initial efficacy of definitive tumor resection combined with percutaneous bacille Calmette-Guérin (BCG) for management of renal pelvic transitional cell carcinoma (TCC) in patients with solitary kidneys.

METHODS

Eight patients with anatomically solitary kidneys, all of whom had a prior history of TCC elsewhere in the urinary tract, were treated with either partial nephrectomy (n = 2) or percutaneous resection (n = 6) combined with a 6-week course of topical BCG administered percutaneously. Seven (87.5%) of the 8 patients tolerated the complete BCG course without adverse effects. One patient required cessation of treatment for renal insufficiency, which resolved with discontinuation of therapy. Follow-up nephroscopy was performed 3 months after the initial tumor resection in 6 of the 8 patients, and all patients underwent regular follow-up surveillance at 3- to 6-month intervals thereafter with radiographic, cytologic, and, in some cases, ureteroscopic examinations.

RESULTS

With follow-up ranging from 9 to 59 (mean, 22) months, local tumor recurrence has become evident in only 1 patient. Two other patients have developed distant metastatic disease, both of whom had invasive TCC elsewhere in the urinary tract prior to treatment of the upper tract tumor.

CONCLUSIONS

Combining a 6-week course of percutaneously administered topical BCG with definitive tumor resection is generally well tolerated, and, ultimately, this protocol may result in a decreased incidence of local tumor recurrence in these high-risk patients.