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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 80-81
Bladder Tuberculosis after BCG Therapy


Departments of Nephrology, Urology, and Pathology, Constantine Military Hospital, Algeria

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   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 2019 Jul 21];19:80-1. Available from: http://www.sjkdt.org/text.asp?2008/19/1/80/37439

   Introduction Top


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.[1],[2],[3] However this thera­peutic approach has many local and systemic side-effects estimated to 5-10%. [4]

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 Top


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 Top


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. [5]

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. [1]

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. [6] 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. [7] The side effects must be identified early and classified for a rational approach. [8]

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 Top

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.  Back to cited text no. 1    
2.Bocco-Gibod L. Endovesical the treatment of bladder tumors for whom? When? How? Semin Uro-Nephrol 1998:243-45.  Back to cited text no. 2    
3.Thierry-flam. Stock of the bladder tumors. Dialog 2001;16:10-1.  Back to cited text no. 3    
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.  Back to cited text no. 4    
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.  Back to cited text no. 5    
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.  Back to cited text no. 6    
7.Gasion JP, Cruz JF. Improving efficacy of intavesical chemotherapy. Eur Urol 2006; 50:225-34.  Back to cited text no. 7    
8.Rischmann P, Desgranchamps F, Malavaud B, Chopin DK. BCG intravesical instillation: recommendations for side-effects manage­ment. Eur Urol 2000;37:33-6.  Back to cited text no. 8    

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Correspondence Address:
A Bouhabel
Constantine Military Hospital, 13 rue Saighi Ahmed SMK, 25003, Constantine
Algeria
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PMID: 18087129

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    Abstract
    Introduction
    Case Report
    Discussion
    References
 

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