Endourology and Stones A 20-Year Experience With Percutaneous Resection of Upper Tract Transitional Carcinoma: Is There an Oncologic Benefit With Adjuvant Bacillus Calmette Guérin Therapy? Ardeshir R. Rastinehad, Michael C. Ost, Brian A. VanderBrink, Kathryn L. Greenberg, Assaad El-Hakim, Robert Marcovich, Gopal H. Badlani, and Arthur D. Smith OBJECTIVES To determine whether there is an oncologic benefit of adjuvant bacillus Calmette Guérin (BCG) after resection of upper tract transitional cell carcinoma (UTTCC). METHODS A total of 133 renal units (RU) treated by percutaneous resection for UTTCC between 1985 and 2005 were retrospectively analyzed. Forty-four RU were excluded because of carcinoma in situ, high grade/stage, metastatic disease present at initial presentation, and/or the patient could tolerate loss of RU. Eighty-nine RU treated primarily by percutaneous resection were then analyzed. Fifty RU received adjuvant BCG therapy 2 weeks after endoscopic management for a total of 6 courses. Recurrence was defined as a positive biopsy result after the third-look nephroscopy. Progression of disease was assessed at time of recurrence and defined as an increase in grade/stage of disease. RESULTS Mean age ( SD) of 89 RU was 70.9  11.1 years. Overall follow-up was 61.1 + 54.8 months. Grade distribution was 56.2% (50 of 89) and 43.8% (39 of 89) for low- and high-grade disease, respectively. There was no statistical difference with regard to tumor grade or stage between treated and nontreated groups (P  .05). Recurrence, time to recurrence, and progression of disease among RU treated with BCG were subselected by grade and compared with the corresponding nontreated group. Statistical significance between any of the treated and non- treated groups was not demonstrated (P  .05). CONCLUSIONS Our data demonstrate that there is no overall oncologic benefit in the administration of adjuvant BCG with regard to disease recurrence, interval to recurrence, and progression of disease in the treatment of UTTCC. UROLOGY 73: 27–31, 2009. © 2009 Elsevier Inc. N ephroureterectomy (NU) is considered the “gold standard” treatment for of upper tract transi- tional cell carcinoma (UTTCC). Kimball and Ferris 1 described the radical treatment of UTTCC in 1934. Since that time minimally invasive endoscopic techniques, including percutaneous surgery and ureteros- copy, have been perfected as alternative therapies with comparative oncologic outcomes when appropriately ap- plied. The history of endoscopic management of UTTCC began in 1985 when Huffman et al 2 reported on a case treated with ureteroscopic resection. Shortly thereafter, Streem et al 3 published the first report of the percutane- ous nephroscopic approach for the treatment of UTTCC. In evaluating the efficacy of definitive endoscopic management of UTTCC, several outcomes need to be assessed, including tumor recurrence, tumor progression, renal preservation rate, overall survival, and cancer-spe- cific survival. Because UTTCC occurs in 2%-5% of all urothelial tumors, 4 it is difficult to accrue a large series of patients or conduct treatment-based randomized trials. MATERIAL AND METHODS A retrospective analysis was performed at our institution of all patients treated primarily by percutaneous resection for UTTCC. Hospital and office charts for patients treated by a single surgeon (A.D.S.) were selected. The review encompassed all visits with the ICD-9 codes 189.0 (kidney, except pelvis) and 189.1 (renal pelvis), operative records for percutaneous From the Arthur Smith Institute for Urology, The North Shore Long Island Jewish Health System, Lake Success, New York Reprint requests: Ardeshir R. Rastinehad, D.O., Arthur Smith Institute for Urology, The North Shore Long Island Jewish Health System, 450 Lakeville Rd, Lake Success, NY 11042. E-mail: asmith@lij.edu Submitted: December 15, 2007, accepted (with revisions): June 1, 2008 © 2009 Elsevier Inc. 0090-4295/09/$34.00 27 All Rights Reserved doi:10.1016/j.urology.2008.06.026