Purpose: The present two-tiered study demonstrates first, the value of upper urinary tract sampling in cytological diagnoses, and multiple cold punch biopsies of bladder, in the cases of carcinoma in situ (CIS) of the urinary tract. The second segment assesses the value of Double-J catheter-based BCG treatment, in the case of positive upper urinary-tract sampling.
Materials and methods: We tested a total thirty three patients (26 man, 7 woman, median age: 67.8 years) who demonstrated two serial positive voiding cytologies. Cystoscopic investigations of bladder tumors, as well as radiologic studies of the upper urinary tract both yielded negative findings. Cytological samples obtained from upper urinary tract of all 33 individuals were next to subjected to multiple cold punch biopsies of bladder.
Results: Among the seven patients whose bladders displayed no abnormalities, cytological tests of the upper urinary tract samples determined that 2 of subjects fell into class III, while the other five were diagnosed class V. In 7 other cases diagnosed as suffering from dysplasia of bladder, cytological findings for two upper urinary tract were class I and II, while one case was class III, and 4 others fell within class V. Of the 19 patients suffering from bladder CIS, eight were diagnosed class I or II, three cases as class III and eight other cases, class V, in upper urinary tract cytologies. At the original site of the urinary CIS, the bladder was affected in 11 cases, the upper urinary tract in 9 patients, and a combined attack on the bladder and upper urinary tract, in 8 others. Of seventeen patients whose upper urinary tract samples produced positive reading, thirteen had had double-J catheter run from bladders to renal pelves as well as treatment consisting of the intravesical instillation of BCG. From thorough cytological evaluations, we learned that the urine of eleven of these 13 individuals, which initially tested positive, had turned negative following intravesical instillation of BCG. Although bladder vesicles proved susceptible to certain minor irritations and slight fevers were not uncommon on treatment-days, such side effects disappeared, once BCG treatment ended.
Conclusions: From painstaking observations, it was concluded that cytological investigations of the upper urinary tract were indispensable to the proper diagnosis of urinary tract CIS, and that intravesical BCG treatment with Double-J catheter is both safe and effective when treating the patients suffering from upper urinary tract CIS.