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PubMed2003

[A case in which severely irritable bladder following intravesical instillation of Bacillus Calmette Guerin was successfully treated by steroid therapy].

We report a patient whose irritable bladder symptoms following Bacillus Calmette Guerin (BCG) instillation were satisfactorily treated by steroid administration. A 59-year-old male had undergone transurethral resection for the bladder carcinoma recurred three times. The histopathological examination revealed the tumor as transitional cell carcinoma, G1 to G2, and pTa. Subsequently an instillation of 80 mg BCG into the bladder was planned 8 times every 7 days. After the 5th instillation he presented with gross hematuria, painful micturition, pollakisuria, urgency and reduced bladder capacity of 15 ml. The dose was reduced to 40 mg and another 3 instillations were accomplished. Since conventional treatments of anti-cholinergics, analgesics and epidural anesthesia were of little help for the subjective symptoms, he was put on the steroid pulse therapy 2 weeks after completion of the BCG regimen. The treatment gradually improved the subjective symptoms and increased the bladder capacity up to 160 ml. In conclusion, we believe that the steroid pulse therapy deserves considering in the early stage of irritable bladder symptoms following BCG instillation.

Administration, Intravesical↗
PubMed1995

Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation.

OBJECTIVES: To determine the minimal active dose and extent of activity of intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. METHODS: Twenty-four adults with grade 3 or 4 hemorrhagic cystitis were treated. All but 2 had failed other local therapy. Treatment was initiated at a median of 32 days post-transplant. Eleven patients received carboprost intravesicularly at 0.2 mg/dL for 60 minutes every 6 hours, and the dose was escalated every 24 hours until a dose of 1.0 mg/dL was reached unless a response was achieved. Thirteen additional patients were treated at an initial dose of 0.8 mg/dL, with escalation to 1.0 mg/dL after four doses in the absence of a response. RESULTS: Overall, 15 of the 24 patients responded. In the dose-escalation setting, 0.8 mg/dL was the minimal active dose. The total response rate was 62% with doses at or above 0.8 mg/dL and 18% at lower doses. All but one response occurred with 7 or fewer days of therapy, and 9 patients relapsed later. Four additional patients were salvaged following cystoscopy with clot evacuation with or without alum or formalin instillation. In all but 1 patient, bladder spasms developed during treatment with carboprost, but were not sufficiently severe to discontinue therapy. CONCLUSIONS: Intravesicular carboprost at 1.0 mg/dL every 6 hours for no more than 7 days should be considered for a randomized study for treatment of refractory hemorrhagic cystitis. Cystoscopic examination and evacuation of clots prior to therapy may be required to achieve the full benefit of this treatment.

Administration, Intravesical↗
PubMedDate not supplied

[Survey of instillation methods of BCG in the preventive treatment of superficial tumors of the bladder. Subcommittee of Superficial Tumors of the Bladder, the Committee of Cancerology of the French Association of Urology].

In an attempt to appreciate urological practices concerning BCG instillations a study was performed with members of university urological centers. Questions concerned instillation modalities, persons performing instillations and criteria for survey. Main differences concerned doses (low doses versus high doses) and duration of treatment. These results suggest the need of development of new parameters for the rationalisation of this treatment.

Administration, Intravesical↗
PubMed2006

[Bladder contracture following intravesical BCG immunotherapy treated by hydrodistention: a case report].

A 35-year-old man had undergone retroperitoneoscopic radical nephrouretectomy in May 2002 (pTisNxM0). He later developed carcinoma in situ (CIS) of the bladder, and underwent intravesical instillation of 80 mg of Bacillus-Calmette-Guerin (BCG) once a week for 6 weeks in January 2004. After the treatment, irritative symptoms (frequency and dysuria) developed, and he was diagnosed with bladder contracture. Conventional treatment with anti-cholinergics, analgesics, anti-tuberculous drugs, and steroids was ineffecsive, but hydrodistention improved the subjective symptoms. Hydrodistention seems to be useful for bladder contracture following intravesical BCG immunotherapy.

Administration, Intravesical↗
PubMed1996

[Granulomatous prostatitis as a complication of BCG intravesical instillation. Report of a case].

OBJECTIVES: Herein we describe a case of granulomatous prostatitis following intravesical instillation of bacillus Calmette-Guerin (BCG) for superficial bladder cancer. METHODS: Patient evaluation included DRE, urine culture, urinary cytology, cystoscopy, PSA determination and transrectal US-guided needle biopsy. RESULTS: On control evaluation two months after intravesical BCG therapy had concluded, the patient referred an episode of suprapubic pain. DRE disclosed an area of increased hardness in one of the prostatic lobes. Urine staining for Mycobacterium was negative and PSA value was 3.5 ng/dl. During transrectal US evaluation, a hypoechoic lesion was detected and biopsied. Analysis of the biopsy specimen disclosed granulomatous prostatitis with caseous necrosis. The patient received antituberculous therapy which achieved clinically good results. CONCLUSIONS: Granulomatous prostatitis is a relatively common complication after intravesical BCG instillation (0.9% of treated patients) and its management includes discontinuation of the instillation and the administration of isoniazid and rifampin. US-guided needle biopsy is warranted to rule out adenocarcinoma of the prostate. BCG instillations are well tolerated in more than 95% of the patients and antituberculous therapy has been proven effective in the management of complications.

Adjuvants, Immunologic↗