尿管ステント留置下でBCG膀胱腔内注入療法が奏効した上部尿路上皮内癌

Upper urinary tract carcinoma in situ responsive to intravesical bacille Calmette-Guérin therapy utilizing DJ catheter：A case report

　症例は72歳，男性。主訴は肉眼的血尿。2003年6月，DIP（点滴静注腎盂造影）・CTにて左腎盂腫瘍と診断し，2003年8月，後腹膜鏡下左腎尿管全摘除術を施行した。以降2回膀胱内再発をきたし，TURBT（経尿道的膀胱腫瘍切除術）と単回膀胱腔内注入療法（初回THP-ADR，2回目MMC）を施行した。2005年5月，尿細胞診が陽性化し，経尿道的膀胱多部位生検術により上皮内癌と診断した。また，同時に右腎盂尿細胞診も陽性であった。2005年6月よりBCG膀胱腔内注入療法を計6回施行した。投与回数の遵守と副作用減少の観点から，前半3回を膀胱腔内注入のみ，後半3回をDJカテーテル併用で上部尿路までBCGを到達させた。重篤な副作用なく経過し，治療後18か月を経過したが尿細胞診，膀胱鏡にて腫瘍の再発を認めていない。

　A 72-year-old man with a chief complaint of gross hematuria was diagnosed as having a left renal pelvic tumor by DIP and CT in June 2003, and underwent retroperitoneoscopic left total nephroureterectomy in August of the same year. Thereafter, the patient had two recurrences of the tumor, and underwent TURBT with intravesical therapy（30mg of THP-ADR at the first recurrence and 10mg of MMC at the second re-currence）. Urinary cytology became positive in May 2005. Multiple transurethral biopsies of the bladder led to a diagnosis of intraepithelial carcinoma. Right renal pelvic urine cytology was also positive. From June 2005, intravesical BCG（connaught strain）therapy was performed in a total of six times. To comply with the number of infusions to be administered and reduce side effects, we performed the first three intravesical therapy alone and the second three intravesical therapy in combination with the use of DJ catheter, thereby delivering BCG into the upper urinary tract. The patient experienced no side-effects from the BCG therapy, and has been free of tumor recurrence for 18 months after treatment, as judged by urine cytology and cystoscopy.（Rinsho Hinyokika 61：835-838, 2007）