Ces Urol 2010, 14(2):92-98 | DOI: 10.48095/cccu2010015

Complications of treatment with bacillus calmette-guerin (BCG) in non-muscle-invasive bladder cancer

Ondřej Havránek, Jan Krhut, David Němec, Roman Král, Zdeněk Haring

Urologické oddělení FN, Ostrava-Poruba

Aim:
Patients with non-invasive transitional cell carcinoma (TCC) a high risk of progresion may benefit from intravesical chemotherapy or immunotherapy Intravesical BCG instillation has better outcomes than Mitomycin instillation in patients with moderate to gross risk of disease progression. However this is accompanied by a higher degree of side effects.

Material and methods:
Together 56 patients were included into the study (42 males and 14 females). All of the patients had histologically proven non-muscle invasive bladder TCC with moderate or high risk of progression. BCG was initiated with six weekly doses followed by maintenance therapy including 3 weekly doses at 3, 6, 9, 12, 15, 21 and 30 months. Median time of instillation was 12,2 months (1,5-30 months).

Results:
In 24 patients (42%) 26 complications were observed. There were 9 not signigicant complications in 7 patients not requiring cessation of BCG therapy. Five patients had 5 moderate side effects and in these patients treatment was interrupted. In this group we restarted with instillations in 12 weeks (4-16 weeks) following diminishing of side effects. Twelve patients suffered 12 severe side effects necessitating treatment to be stopped.

Conclusion:
Intravesical BCG instillation is effective in patients with non-muscle invasive TCC who have moderate or high risk of disease progression. Unfortunately is associated with high de-grese of side effects - both local and general. It is possible to decrease the extent of these complications by means of proper indication for treatment, by minimising trauma during catheterisation and by applying sterile technique of catheterisation. Next option is prophylactic use of antibiotics.

Keywords: BCG, cystitis, epididymitis, haematuria, intravesical immunotherapy, transurethral tumour resection

Received: May 11, 2009; Accepted: March 2, 2010; Published: March 1, 2010