# 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

## TL;DR

A patient with cancer in both upper urinary tracts achieved long-term remission using a new BCG treatment method after traditional methods failed.

## Contribution

A novel retrograde BCG delivery method via open-ended ureteral catheters is proposed for kidney-sparing treatment of UUT CIS.

## Key findings

- Intravesical BCG via double-J stents failed to clear UUT CIS in the patient.
- Retrograde BCG via open-ended catheters led to 3 years of complete remission.
- The method may offer better drug exposure to the UUT urothelium than traditional stents.

## Abstract

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.

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.

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.