Bacillus Calmette-Guérin therapy in the management of upper tract urothelial carcinoma in-situ: a systematic review

Introduction

Upper tract urothelial carcinoma (UTUC) is an uncommon malignancy, accounting for approximately 5–10% of all urothelial cancers and primarily involving the renal pelvis and ureter (1). Carcinoma in-situ (CIS) of the upper urinary tract (UUT) represents a particularly aggressive disease entity, characterised by flat, high-grade lesions with a recognised risk of progression to invasive disease (1,2). Radical nephroureterectomy (RNU) has historically been regarded as the standard treatment for high-risk UTUC, including CIS, despite renal loss and peri-operative risks (1).

Over the past two decades, advances in endoscopic technology and diagnostic techniques have driven increasing interest in kidney-sparing management strategies for UTUC, alongside growing awareness of the long-term consequences of renal impairment (2,3). This shift has been particularly relevant for patients with imperative indications for renal preservation, such as solitary kidneys, bilateral disease, chronic kidney disease, or significant comorbidity. In this setting, topical therapies delivered directly to the upper tract have emerged as potential alternatives to radical surgery in carefully selected patients (4).

Bacillus Calmette-Guérin (BCG) immunotherapy is an established treatment for non-muscle-invasive bladder cancer and provides durable disease control in bladder CIS through immune-mediated anti-tumour effects (2). On the basis of this efficacy, topical BCG has been explored as a kidney-sparing option for UUT-CIS using antegrade or retrograde instillation (2,4). However, delivery in the upper tract is technically challenging, with variable drug exposure, anatomical constraints and heterogeneous techniques (3).

The evidence supporting topical BCG for upper tract CIS remains limited, being largely derived from small observational series with substantial heterogeneity in patient selection, diagnostic criteria, BCG strains, dosing regimens, and follow-up protocols, and subsequently highly variable oncological and toxicity outcomes (3,4). Consequently, major international guidelines continue to regard BCG therapy for upper tract CIS as investigational (1). In light of these limitations, this systematic review aims to synthesise the available evidence on oncological outcomes and adverse events associated with topical BCG therapy for UUT-CIS, focusing on treatment response, recurrence, progression, renal unit preservation, and treatment-related toxicity. We present this article in accordance with the PRISMA reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0232/rc).

Methods

Search strategy

A comprehensive search was performed in September 2025 of PubMed (NCBI), Embase (Elsevier), the Cochrane Central Register of Controlled Trials, and Web of Science (Core Collection). Searches were conducted using three predefined concepts: (I) BCG, (II) CIS, and (III) UUT. For each concept, controlled vocabulary terms were identified. The search strategy used the following terms: BCG Vaccine, Bacillus Calmette-Guérin, Bacillus Calmette Guerin, carcinoma in-situ, CIS, ureter, renal pelvis, UTUC, upper tract urothelial carcinoma, upper urinary tract, upper tract, and pelvicalyceal. Related terms within each concept were combined using the Boolean operator OR and the three concepts were combined using AND. The full database-specific search strings are provided in Appendix 1. Grey literature sources were also searched to identify unpublished or ongoing studies; these included ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (Appendix 1).

Inclusion criteria

This study was pre-registered on PROSPERO (registration No. CRD420261277998). Two authors independently screened search results (Y.G., D.A.) with elimination of ineligible studies occurring successively after review of titles, then abstracts, then full-text articles. Data extraction was performed independently by two authors (Y.G., D.A.) utilising a standardised form, and undertaken twice for accuracy (Appendix 2). Disagreements were resolved by a third author (D.H.).

Study eligibility

The patient population, intervention, control, outcome and study type (PICOS) approach was used to define eligible studies. Eligible studies enrolled adult patients with upper tract CIS (P), who received topical BCG therapy to the UUT via any route (I), with or without a comparator cohort (C), and reported oncological outcomes [such as complete response (CR), recurrence, progression, renal unit preservation] or reported BCG-related adverse events (O). Eligible studies were written in English language, original, published 01/01/2000–14/09/2025 and could be either randomised or non-randomised (S).

Studies were excluded if they enrolled patients with metastatic or muscle-invasive disease, administered BCG intravesically for bladder cancer rather than for upper tract lesions, or combined bladder and upper tract results without separate analysis. Studies were also excluded if they evaluated non-BCG topical agents only (such as mitomycin or gemcitabine), reported ex-vivo or animal models, or described isolated case reports/series with fewer than five treated renal units. Duplicate publications or overlapping patient cohorts from the same centre were excluded, with the most complete or recent dataset retained. Studies were excluded if they failed to report clinical outcomes (such as response, recurrence, progression, or adverse events) specific to BCG-treated upper tract disease, or if outcome data could not be extracted in a usable form. Figure 1 shows PRISMA flow diagram of study selection.

Figure 1 PRISMA flow diagram of study selection (adapted from the PRISMA 2020 statement).

Intended analyses

The primary outcomes were response and recurrence rates following topical BCG therapy for UUT-CIS. Secondary outcomes included progression rate, renal unit preservation rate, BCG-related adverse events (local and systemic), BCG discontinuation due to toxicity, and treatment-related mortality.

A descriptive summary was planned for all data, with studies grouped by prespecified outcomes of CR, recurrence, progression, renal unit preservation, and adverse events. If studies of sufficiently similar methodology were found, then meta-analyses were intended using Review Manager Software (the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark).

Assessment of bias

Based on prior systematic reviews, randomised studies were not expected to be identified. Therefore, the Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool (version 2) was used to assess risk of bias (5). Each study was independently scored by two authors (Y.G., D.H.) using a standardised form (Appendix 2). Disagreements were resolved by a third author (D.A.). Publication bias could not be formally assessed due to heterogeneity and absence of pooled effect estimates.

Results

Study selection

The database search identified 557 records. After removal of duplicates, 353 unique records remained for title and abstract screening. Of these, 51 articles were retrieved for full-text assessment. Following full-text review, studies were excluded for publication outside the pre-specified date range of 2000–2025 (16 studies), inappropriate study design including conference abstracts, case reports, and review articles (14 studies), publication in a non-English language (3 studies), ineligible patient population (mixed UTUC cohorts without stratified UUT-CIS data or studies limited to non-muscle invasive bladder cancer) (3 studies), and overlapping patient populations (one study). Fourteen studies met the eligibility criteria (2-4,6-16) (Figure 1).

Study characteristics

The 14 included studies comprised 298 renal units, defined as individual kidneys with their associated collecting systems. The overall cohort comprised 267 patients with an estimated weighted mean age of 71.8 years (calculated from 225 of 267 patients with age data reported as either median or mean) (Table 1). Sex was reported in 13 of 14 studies (229 patients), comprising 185 males (80.8%) and 44 females (19.2%). Because many studies report outcomes per renal unit and some patients have bilateral involvement, outcomes are presented per renal unit; where patient-level data only were reported, these are noted (Tables 1,2). All studies were observational in design, including retrospective cohort studies and single-arm case series; no randomised controlled trials were identified. Sample sizes ranged from 8 to 52 renal units per study. Average follow-up duration ranged from 13–88 months, and was variably reported as median or mean (Table 1). Owing to substantial methodological heterogeneity across included studies, quantitative synthesis was deemed inappropriate and statistical pooling was not performed. Therefore, a systematic review without meta-analysis was conducted.

Topical BCG was administered via antegrade (4 studies), retrograde (3 studies), or combined approaches (7 studies), with no standardised protocol across studies. Antegrade delivery refers to instillation directly into the upper tract via PCN, allowing BCG instillation from the renal pelvis distally. Retrograde delivery typically involved placement of a ureteric stent or catheter. In some studies, retrograde reflux delivery was performed involving placement of a ureteric stent to induce vesicoureteral reflux (3,4,6,7,9-12,14,15). Considerable heterogeneity was observed in dosing, proof of reflux, dwell time, and use of maintenance therapy. Across studies, BCG dosing ranged from 40–81 mg. Proof of reflux was only reported in 8 of the 10 studies that utilised retrograde reflux delivery. Reporting of infusion and retention time was inconsistent, ranging from 1 to ≥2 hours for infusion and ≥0.5 to ≥2 hours for retention (Table 1). BCG induction schedule consisted of 6 weekly instillations for all studies, except for Tomisaki et al. 2018 in which 8 weekly instillations were administered. Two studies formally compared antegrade and retrograde delivery methods: Fontanet et al. 2023 reported no statistically significant difference in oncological outcomes between approaches (P=1), while McElree et al. 2024 found PCN administration to be associated with a significantly increased risk of recurrence compared with retrograde catheter delivery (hazard ratio 3.89, 95% confidence interval: 1.59–9.53; P<0.01) (3,16). An additional source of variability is the use of repeat induction of BCG following initial therapy. Ten studies reported some use of second BCG induction among patients who did not achieve CR following initial BCG induction or among patients with recurrence (2,7-15). Two studies, Shapiro et al. 2012 and McElree et al. 2024, also reported the use of maintenance therapy provided to patients achieving CR following an initial induction course (13,16). These also differed substantially in timing and dosage.

Four different BCG strains were used across studies, either exclusively or in parallel with other strains. These included Tokyo-172 (9/14 studies), Immun BCG Pasteur F (2/14), ImmuCyst Connaught (3/14), and TICE BCG (1/14; Table 1). Baseline patient and disease characteristics, diagnostic methods, delivery approaches, dosing regimens, and follow-up protocols are summarised in Table 1. Timing of the first post-induction assessment varied widely, ranging from 1 to 24 weeks across studies (Table 2). Importantly, outcome definitions were intrinsically linked to the diagnostic method utilised; histopathology, cytology, cystoscopy, and imaging (Table 2).

Primary outcomes: CR and recurrence

CR following completion of an induction course of topical BCG therapy was reported in 13 of the 14 included studies. Definitions of CR varied substantially and typically incorporated combinations of negative urinary cytology, endoscopic findings at ureteroscopy, histological assessment from biopsy, and radiographic evaluation. Among studies reporting CR, response rates ranged from 59% to 100% per renal unit (Table 2).

Recurrence outcomes were reported in 12 studies overall. Recurrence following an initial CR was specifically reported in 10 studies. Among these cohorts, recurrence rates ranged from 0% to 70% per renal unit (Table 2). Differences in surveillance protocols, diagnostic thresholds, and timing of follow-up assessments limited direct comparison between studies.

Secondary outcomes: progression, radical surgery, and renal unit preservation

Progression outcomes were reported in 13 studies. Definitions of progression varied; among 10 of these studies, this was defined as progression following an initial CR to therapy. Reported progression rates ranged from 0% to 43% per renal unit (Table 2), which likely reflects in disease definitions, follow-up duration, and progression criteria. Across included studies, the proportion of renal units requiring salvage RNU by the end of follow-up ranged from 0% to 25% (Table 2). Indications for salvage RNU were variably defined but most commonly included disease recurrence, progression to higher-grade or invasive disease, or failure to achieve or maintain a CR following induction therapy.

Kidney preservation outcomes were available for all included studies. Preservation was defined as renal units not undergoing RNU at the end of follow-up and was either explicitly reported or derived from study-level RNU data. Preservation rates ranged from 45% to 100% across studies (Table 2). Interpretation of these findings is limited by renal unit-level reporting, heterogeneous denominators, and inconsistent stratification by response status or disease severity, in the context of methodological variability across studies.

Adverse events and treatment-related toxicity

Adverse events related to topical BCG therapy were variably reported, with substantial heterogeneity in event definitions, severity grading, and reporting denominators. Formal toxicity grading systems, such as Clavien-Dindo classification, were rarely applied (17). Most reported adverse events were local and self-limited, including dysuria, urinary frequency, flank pain, fever, and irritative lower urinary tract symptoms. Systemic adverse events were uncommon and inconsistently defined, with isolated reports of sepsis. Discontinuation of BCG therapy due to treatment-related toxicity was reported in a minority of studies. Treatment-related mortality was rare and occurred in one patient (Table 3). Given inconsistent reporting and variable attribution, adverse events were summarised descriptively rather than pooled (Table 3).

Risk of bias assessment

Risk of bias was assessed using the ROBINS-I framework (5,18), which is appropriate for non-randomised studies. Given the rarity of UUT-CIS, all included studies were observational and therefore subject to inherent confounding and selection bias. Overall, most studies demonstrated a moderate risk of bias across key ROBINS-I domains, reflecting well-defined treatment pathways, objective outcome assessment, and structured follow-up protocols. Comparative cohort studies generally demonstrated lower risk of bias due to clearer eligibility criteria and statistical adjustment for confounders. In contrast, single-arm case series reflected real-world practice in imperative kidney-sparing scenarios but were limited by absence of control groups (Figures S1,S2). The overall body of evidence remains constrained by the lack of randomised trials, and findings should be interpreted within this context.

Discussion

This review synthesises the current evidence on topical BCG therapy for UUT-CIS, a treatment strategy that has been utilised as a kidney-sparing alternative to RNU in selected clinical scenarios. The available literature remains limited and consists exclusively of retrospective observational studies (2-4,6-16). The anti-tumour effect of BCG is well established in urothelial carcinoma of the urinary bladder (19-21). In bladder CIS, the European Association of Urology (EAU) recommends intravesical therapy for intermediate or high risk disease, with intravesical BCG preferred over chemotherapy due to superior response and progression outcomes (20). In contrast, EAU guidelines for UUT-CIS describe topical BCG therapy as investigational, reflecting the limited and heterogeneous evidence base, and recommend its consideration only in carefully selected patients particularly when RNU is not feasible or is associated with unacceptable morbidity (1). The American Urological Association (AUA) similarly notes BCG may be offered in imperative conditions such as solitary kidney status, bilateral disease, or risk of progression to end stage disease (22).

Across 14 studies comprising 298 treated renal units, topical BCG therapy was associated with high initial CR rates, meaningful renal unit preservation, and low rates of severe adverse events and treatment-related mortality. However, recurrence and progression rates varied widely across studies. Collectively, these findings suggest that while topical BCG therapy is not equivalent to RNU from an oncological standpoint, it may represent a reasonable kidney-sparing option in selected patients, particularly those with imperative indications for renal preservation. Importantly, kidney preservation was achieved in a substantial proportion of cases, with salvage RNU remaining a feasible and oncologically appropriate option in the event of recurrence.

The most consistent finding across the included studies was a high initial response following BCG induction. CR rates ranged from 59% to 100% per renal unit, despite substantial variability in CR definitions, diagnostic modalities, and timing of post-treatment assessment (Tables 1,2). This supports the biological plausibility that BCG can exert clinically meaningful antitumour activity against flat, high-grade urothelial lesions in the upper tract, analogous to its established efficacy in bladder CIS (19,21,23).

Despite these encouraging early response rates, evidence regarding durable oncological control remains inconsistent. Among studies reporting recurrence following an initial CR, recurrence rates ranged from 0% to 70% per renal unit (Table 2). Similarly, progression rates following CR varied from 0% to 43% (Table 2). This wide variability likely reflects heterogeneity in patient selection, treatment protocols, delivery techniques, and surveillance strategies rather than true biological inconsistency alone. Definitions of recurrence and progression were not standardised, follow-up durations varied substantially, and the timing of first post-induction assessment ranged from 1 to 24 weeks. Collectively, these factors limit direct comparison between studies and complicate inference regarding long-term oncological efficacy.

Differences in outcomes are also likely related to variation in how BCG was delivered. Across studies, BCG was administered using antegrade instillation through a percutaneous nephrostomy, retrograde instillation via a ureteral catheter or stent, or a combination of approaches. There was little standardisation in dwell time, dosing, or use of maintenance therapy (Table 1). Although limited non-randomised comparative human data exist (3,16), experimental evidence cited by Redrow et al. 2017 further suggests that method of administration may meaningfully influence urothelial exposure. Specifically, open-ended ureteral catheter delivery may achieve greater mucosal surface coverage than nephrostomy-based instillation, and both may provide superior exposure compared with passive reflux via indwelling ureteral stents (24-26).

Adverse events associated with topical BCG therapy were predominantly local and self-limited across included studies. Commonly reported adverse events included dysuria, urinary frequency, flank pain, fever, and irritative lower urinary tract symptoms. Severe systemic toxicity was uncommon, and treatment-related mortality was reported in a single patient. However, adverse event reporting was inconsistent, frequently narrative in nature, and rarely incorporated formal severity grading, limiting robust comparison between study cohorts (Table 3). Despite these limitations, the overall safety profile of topical BCG therapy appeared acceptable among carefully selected patients.

The findings of this review support current EAU and AUA recommendations regarding the role of topical BCG therapy in UUT-CIS (1,22). The high initial CR rates and substantial renal unit preservation observed provide justification for its selective use in kidney-sparing contexts. Comparable CR rates following topical BCG therapy have been reported in prior evidence syntheses (3,23,27). However, unlike earlier reviews that evaluated intraluminal therapies broadly or included heterogeneous upper tract urothelial carcinoma populations, the present review focuses specifically on BCG therapy in UUT-CIS. Existing syntheses also indicate that BCG is the most frequently utilised intraluminal agent for UUT-CIS. While some reviews have suggested higher CR rates with BCG compared with mitomycin-based therapies, these observations derive from heterogeneous populations and do not constitute direct comparative evidence. At present, no comparative data conclusively demonstrates oncological superiority of BCG over other intraluminal agents such as mitomycin C, gemcitabine, or docetaxel in UUT-CIS (23). However, in bladder CIS, randomised trials and meta-analyses have demonstrated superior recurrence and progression outcomes with intravesical BCG compared with chemotherapy, a finding that has supported extrapolation of BCG use to the upper tract (19,28). The substantial variability in recurrence and progression observed in the present review reinforces why RNU remains the current oncological standard of care (1,22,29,30).

Several limitations must be considered when interpreting these findings. All included studies were retrospective and observational, introducing inherent risks of selection bias and confounding (5). No randomised or prospective comparative studies were identified. Heterogeneity existed in patient selection, diagnostic criteria, BCG delivery techniques, dosing regimens, and surveillance protocols. Definitions of CR, recurrence, and progression were also not standardised. Furthermore, heterogeneity in outcome definitions existed due to inherent differences in diagnostic definitions and assessment methods. Prospective studies employing consistent delivery methods, outcome definitions aligned with diagnostic criteria, and follow-up schedules are required. Given the absence of comparative evidence, standardisation of delivery technique may not be currently feasible. Rather, consistent reporting of technique-specific parameters, such as route, dwell time, and reflux confirmation, are needed to allow meaningful comparison across studies.

Conclusions

Topical BCG therapy for UUT-CIS is associated with high initial CR rates, acceptable toxicity, and meaningful renal unit preservation in selected patients. However, long-term oncological outcomes remain variable, with wide ranges in reported recurrence and progression, reflecting substantial heterogeneity in patient selection, delivery techniques, and follow-up protocols. In the absence of comparative or randomised data, topical BCG should not be considered equivalent to RNU, which remains the oncological standard of care.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the PRISMA reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0232/rc

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0232/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0232/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Masson-Lecomte A, Birtle A, Pradere B, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: Summary of the 2025 Update. Eur Urol 2025;87:697-716. [Crossref] [PubMed]
2. Giannarini G, Kessler TM, Birkhäuser FD, et al. Antegrade perfusion with bacillus Calmette-Guérin in patients with non-muscle-invasive urothelial carcinoma of the upper urinary tract: who may benefit? Eur Urol 2011;60:955-60. [Crossref] [PubMed]
3. Fontanet S, Gallioli A, Baboudjian M, et al. Topical instillation of BCG immunotherapy for biopsy-proven primary upper urinary tract carcinoma in situ: A single institution series and systematic review. Urol Oncol 2023;41:274-83. [Crossref] [PubMed]
4. Territo A, Fontanet S, Meneghetti I, et al. Management of primary upper urinary tract carcinoma in situ diagnosed by ureteroscopic biopsy: Is bacillus Calmette-Guerin an alternative to nephroureterectomy? Actas Urol Esp (Engl Ed) 2023;47:221-8. [Crossref] [PubMed]
5. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919. [Crossref] [PubMed]
6. Nishino Y, Yamamoto N, Komeda H, Takahashi Y, Deguchi T. Bacillus Calmette-Guérin instillation treatment for carcinoma in situ of the upper urinary tract. BJU Int 2000;85:799-801. [Crossref] [PubMed]
7. Nonomura N, Ono Y, Nozawa M, et al. Bacillus Calmette-Guérin perfusion therapy for the treatment of transitional cell carcinoma in situ of the upper urinary tract. Eur Urol 2000;38:701-5.
8. Okubo K, Ichioka K, Terada N, Matsuta Y, Yoshimura K, Arai Y. Intrarenal bacillus Calmette-Guérin therapy for carcinoma in situ of the upper urinary tract: long-term follow-up and natural course in cases of failure. BJU Int 2001;88:343-7. [Crossref] [PubMed]
9. Irie A, Iwamura M, Kadowaki K, et al. Intravesical instillation of bacille Calmette-Guérin for carcinoma in situ of the urothelium involving the upper urinary tract using vesicoureteral reflux created by a double-pigtail catheter. Urology 2002;59:53-7. [Crossref] [PubMed]
10. Miyake H, Eto H, Hara S, et al. Clinical outcome of bacillus Calmette-Guérin perfusion therapy for carcinoma in situ of the upper urinary tract. Int J Urol 2008;9:677-80. [Crossref] [PubMed]
11. Hayashida Y, Nomata K, Noguchi M, et al. Long-term effects of bacille Calmette-Guérin perfusion therapy for treatment of transitional cell carcinoma in situ of upper urinary tract. Urology 2004;63:1084-8. [Crossref] [PubMed]
12. Kojima Y, Tozawa K, Kawai N, et al. Long-term outcome of upper urinary tract carcinoma in situ: Effectiveness of nephroureterectomy versus bacillus Calmette-Guérin therapy. Int J Urol 2006;13:340-4. [Crossref] [PubMed]
13. Shapiro EY, Lipsky MJ, Cha DY, et al. Outcomes of intrarenal Bacillus Calmette-Guérin/interferon-α2B for biopsy-proven upper-tract carcinoma in situ. J Endourol 2012;26:1645-50. [Crossref] [PubMed]
14. Horiguchi H, Yoneyama T, Hatakeyama S, et al. Impact of bacillus Calmette-Guérin therapy of upper urinary tract carcinoma in situ: comparison of oncological outcomes with radical nephroureterectomy. Med Oncol 2018;35:41. [Crossref] [PubMed]
15. Tomisaki I, Kubo T, Minato A, Fujimoto N. Efficacy and Tolerability of Bacillus Calmette-Guérin Therapy as the First-Line Therapy for Upper Urinary Tract Carcinoma In Situ. Cancer Invest 2018;36:152-7. [Crossref] [PubMed]
16. McElree IM, Mott SL, Hougen HY, et al. Sequential endoluminal gemcitabine and docetaxel vs. Bacillus Calmette-Guérin for the treatment of upper tract carcinoma in situ. Urol Oncol 2024;42:221.e9-221.e16.
17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13. [Crossref] [PubMed]
18. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 2021;12:55-61. [Crossref] [PubMed]
19. Sylvester RJ, van der Meijden AP, Witjes JA, et al. Bacillus calmette-guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: a meta-analysis of the published results of randomized clinical trials. J Urol 2005;174:86-91; discussion 91-2. [Crossref] [PubMed]
20. Gontero P, Birtle A, Capoun O, et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)-A Summary of the 2024 Guidelines Update. Eur Urol 2024;86:531-49. [Crossref] [PubMed]
21. Redelman-Sidi G, Glickman MS, Bochner BH. The mechanism of action of BCG therapy for bladder cancer--a current perspective. Nat Rev Urol 2014;11:153-62. [Crossref] [PubMed]
22. Coleman JA, Clark PE, Bixler BR, et al. Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline. J Urol 2023;209:1071-81. [Crossref] [PubMed]
23. Khargi R, Connors C, Ricapito A, et al. Adjuvant intraluminal therapies for upper tract urothelial carcinoma. Transl Androl Urol 2023;12:1439-48. [Crossref] [PubMed]
24. Redrow GP, Guo CC, Brausi MA, et al. Upper Urinary Tract Carcinoma In Situ: Current Knowledge, Future Direction. J Urol 2017;197:287-95. [Crossref] [PubMed]
25. Pollard ME, Levinson AW, Shapiro EY, et al. Comparison of 3 upper tract anticarcinogenic agent delivery techniques in an ex vivo porcine model. Urology 2013;82:1451.e1-6. [Crossref] [PubMed]
26. Liu Z, Ng J, Yuwono A, et al. Which is best method for instillation of topical therapy to the upper urinary tract? An in vivo porcine study to evaluate three delivery methods. Int Braz J Urol 2017;43:1084-91.
27. Wong CH, Leung DK, Ko IC, et al. A Systematic Review of Intracavitary Therapies for Upper Tract Urothelial Carcinoma. Eur Urol Oncol 2025; Epub ahead of print. [Crossref]
28. Böhle A, Jocham D, Bock PR. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol 2003;169:90-5. [Crossref] [PubMed]
29. Seisen T, Peyronnet B, Dominguez-Escrig JL, et al. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel. Eur Urol 2016;70:1052-68. [Crossref] [PubMed]
30. Ploussard G, Xylinas E, Lotan Y, et al. Conditional survival after radical nephroureterectomy for upper tract carcinoma. Eur Urol 2015;67:803-12. [Crossref] [PubMed]