A Bouhabel, F Takoucht, W Bousbia, B Hamada, N Lemaiaci
Departments of Nephrology, Urology, and Pathology, Constantine Military Hospital, Algeria
Click here for correspondence address and email
| Abstract|| |
The initial treatment of bladder cancer is transurethral resection (TUR), but this cancer recurs at an important rate, and has 14% chance of progression after TUR alone. Intravesical chemotherapy with Bacillus Calmette-Guerin (BCG) is effective against recurrence and progression of bladder cancer. However, this therapeutic expose to many local and systemic side-effects. We report a case of 63-year-old man who presented bladder tuberculosis after a BCG therapy, which required 6 months of antitubercular therapy.
Keywords: Bladder cancer, BCG therapy, Tuberculosis, Antitubercular
|How to cite this article:|
Bouhabel A, Takoucht F, Bousbia W, Hamada B, Lemaiaci N. Bladder Tuberculosis after BCG Therapy. Saudi J Kidney Dis Transpl 2008;19:80-1
|How to cite this URL:|
Bouhabel A, Takoucht F, Bousbia W, Hamada B, Lemaiaci N. Bladder Tuberculosis after BCG Therapy. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Jan 29];19:80-1. Available from: http://www.sjkdt.org/text.asp?2008/19/1/80/37439
| Introduction|| |
Intravesical chemotherapy with Bacillus Calmette-Guerin (BCG) prevents recurrence and progression of the primary bladder tumor in 47% versus 12.6 to 23.8% for transurethral resection (TUR) alone.,, However this therapeutic approach has many local and systemic side-effects estimated to 5-10%. 
In a attempt to reduce these adverse events and increase efficiency of instillations, we must respect the administration modalities and to do an early screening to propose different alternative treatment suitable for each case.
| Case Report|| |
63-year-old man has been treated for a bladder tumor (pT1G3) by six then three additional BCG instillations that were accompanied by a serious cystitis manifested as macroscopic hematuria with clots. A cystoscopy and biopsy were performed, which revealed follicular bladder tuberculosis.
The patient receives antispasmodic, analgesic and fluoroquinolone with anti inflammatory drugs without a significant response. We initiated antituberculus therapy with 0.5mg/ kg/daily of prednisone during the following two months. The patient responded with clear urine. The tolerance of the antituberculus drugs was excellent.
| Discussion|| |
Side-effects are frequent during intravesical bacillus Calmette-Guerin chemotheraphy, which can cause delay or interruption of the instillations and consequently reduces the efficacy of treatment. 
The traumatic instillation exposes the bladder to serious adverse events. Risk is higher during the first nine instillations, but evidence for increased BCG toxicity during maintenance therapy was not found. 
To reduce the incidence of side-effects and improve efficiency, urinalysis is necessary before each instillation. Soft sounding of the urethra with a little gauge sound is the second step before instillation.  The bladder must be completely empty before instillation. Fasting six hours before treatment is recommended to prevent drug dilution. Administration of oral desmopressin 0.2 mg one hour before each instillation increases intravesical drug concentration. To augment bladder wall penetrations, drugs must be retained as long as possible. Lastly, instillations must be performed immediately postoperatively in all superficial tumors.  The side effects must be identified early and classified for a rational approach. 
In conclusion, intravesical Bacillus CalmetteGuerin for superficial bladder cancer is used to prevent tumor recurrence and progression. However side effects are commonly manifested during this therapeutic approach. The use of these instillations needs a strict administration technique and strict monitoring of the patient to reduce the incidence of the side effects.
| References|| |
|1.||Bohle 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. |
|2.||Bocco-Gibod L. Endovesical the treatment of bladder tumors for whom? When? How? Semin Uro-Nephrol 1998:243-45. |
|3.||Thierry-flam. Stock of the bladder tumors. Dialog 2001;16:10-1. |
|4.||Prevention and treatment side effects (EI) associated with bacillus Calmette-Guerin (BCG) in the treatment of superficial bladder tumors. J Urol 2002;36:120-31. |
|5.||Bassi P, Spinadin R, Carando R, Balto G, Pagaro F. Modified induction course: a solution to side-effects? Eur Urol 2000; 37:31-2. |
|6.||Saint F, Salomon L, Quintela R, Cicco A, Abbou CC, Chopin DK. Classification: enabling factors; Bocco-gibod L. Accident prevention of BCG therapie endovesical. Prog Urol 1997;7:1-2. |
|7.||Gasion JP, Cruz JF. Improving efficacy of intavesical chemotherapy. Eur Urol 2006; 50:225-34. |
|8.||Rischmann P, Desgranchamps F, Malavaud B, Chopin DK. BCG intravesical instillation: recommendations for side-effects management. Eur Urol 2000;37:33-6. |
Constantine Military Hospital, 13 rue Saighi Ahmed SMK, 25003, Constantine