Korean J Urol.  2006 Apr;47(4):436-439. 10.4111/kju.2006.47.4.436.

Ureteral Obstruction Caused by Periureteral Tuberculous Granuloma after Intravesical BCG Therapy for Superficial Bladder Tumors

• Nam SB
• Park JS
• Kim JJ
• Park JT
• Nam SK

• KMID: 1997156
• DOI: http://doi.org/10.4111/kju.2006.47.4.436

Abstract

Bacillus Calmette-Guerin (BCG) is an attenuated strain of Mycobacterium bovis (M. bovis) that has been used to treat transitional cell carcinoma. Since the initial report by Morales and associates on the use of intravesical BCG for the treatment of recurrent superficial bladder tumors, intravesical therapy with BCG has proved to be more effective for prophylaxis and the treatment of superficial bladder tumors and carcinoma in situ than most of the standard chemotherapeutic agents. While the majority of patients tolerate BCG treatments well, a number of adverse reaction (e.g., fever, hematuria, dysuria, nausea and malaise) have been reported. More serious complications occur on rare occasions and they include pneumonitis/hepatitis, ureteral obstruction, renal abscess and sepsis. We report here on a case of ureteral obstruction that was caused by periureteral tuberculous granuloma after intravesical BCG therapy for superficial bladder tumors, and the condition required distal ureterectomy & ureteroneocystostomy.

Keyword

Mycobacterium bovis; Bladder neoplasms; Granuloma; Ureteral obstruction

MeSH Terms

Abscess
Bacillus
Carcinoma in Situ
Carcinoma, Transitional Cell
Dysuria
Fever
Granuloma*
Hematuria
Humans
Morale
Mycobacterium bovis*
Nausea
Sepsis
Ureter*
Ureteral Obstruction*
Urinary Bladder Neoplasms*
Urinary Bladder*

Figure

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  Fig. 1 (A) Abdominal CT at preoperative (TURBT) shows no specific finding except for the contrast media-filled intestine because of a prior former barium enema. (B) The preoperative a abdominal CT (distal ureterectomy & ureteroneocystostomy) shows obstruction of the left lower ureter with circular calcification after BCG instillation.

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  Fig. 2 Gross finding of periureteric soft tissue shows pale yellow caseous necrosis, about 2.7×2.0cm on the cross diameter.

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  Fig. 3 Microscopic finding of periureteric soft tissue shows two large granulomas with central caseous necrosis compressing the ureter (H&E, ×12.5).

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  Fig. 4 Microscopic finding of periureteric soft tissue shows granulomas consisting of epitheloid histocytes cuffed by lymphocytes & plasma cells, Langerhan's type giant cells and chronic inflammatory cells (H&E, ×200).

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