Management, and Prevention, of Intravesical Therapy Complications

Abstract

The urologist must prevent, identify and properly treat the complications of intravesical chemotherapy and immunotherapy. Both local and systemic toxicity of adjuvant intravesical therapy is herein analyzed. Topical toxicity is mainly due to the inflammation induced by the contact between the instilled agent and the bladder mucosa. MATERIAL AND METHODS. The factors predisposing to topical toxicity must be identified and removed before starting the treatment. The choice of the agent, its dose, concentration and dosage must be tailored, whenever possible, to the presence of the above mentioned factors. Mitomycin and BCG can rarely provoke chronic cystitis, severely compromising bladder function. RESULTS. The most dangerous complication of early intravesical chemotherapy is the instillation in presence of an unrecognized bladder perforation. Flu-like syndrome, fever, chills, arthralgia are reported in almost 20% of patients receiving BCG. If fever persists for more than 48 hours or exceeds 38.5 °C, isoniazid must be administered and BCG stopped until complete remission. BCG sepsis is a rare but severe complication that must be promptly recognized and treated. If not, a life-threatening multi-organ failure syndrome can arise. Isoniazid and rifampicin, adding ethambutol when required, must be administered for a prolonged period until complete remission. CONCLUSIONS. Granulomatous lesions represent the main other rare systemic complications of BCG therapy. Systemic toxicity of intravesical chemotherapy is rare, due to the high molecular weight of the drugs, limiting systemic absorption.

Formulation and characterization of EGCG for the treatment of superficial bladder cancer

“…To prevent this scenario, patients are treated with intravesical therapy with BCG bacterium related to tuberculosis (51,52), or MMC following resection or fulguration (destroying the lesion by electric current) or both agents (53). BCG, a form of immunotherapy, can cause side-effects, such as flu-like syndrome with fever, chills and fatigue, cystitis, or a more serious systemic reaction which rarely leads to death (54,55). MMC is utilized similarly and carries its own drawbacks to clinical use, including bladder infection, irritative voiding symptoms, special handling and preparation precautions, and bladder calcifications among others (55–58).…”

“…BCG, a form of immunotherapy, can cause side-effects, such as flu-like syndrome with fever, chills and fatigue, cystitis, or a more serious systemic reaction which rarely leads to death (54,55). MMC is utilized similarly and carries its own drawbacks to clinical use, including bladder infection, irritative voiding symptoms, special handling and preparation precautions, and bladder calcifications among others (55–58). …”

Frequency of Complications Post-Intravesical BCG Instillation in Patients with Superficial Urinary Bladder Carcinoma

“…Complications of BCG therapy are most commonly cystitis and low-grade fever with bodyaches. 4 BCG-related epididymo-orchitis has been reported in case studies. 5 Other side effects observed include nausea, hematuria, and dysuria.…”

Adverse Events after Intravesical Therapy: Are we Always Ready to Recognize and Prevent them?

“…Eventi avversi sistemici di entità lievemoderata sono frequenti durante il trattamento con BCG (flu-like syndrome e febbre <38.5 °C) e si risolvono abitualmente entro 48 ore. Febbre elevata e persistente può essere segno di infezione sistemica da BCG e sepsi, che possono essere precipitate da ulteriori instillazioni di farmaco. Sebbene di rado, infezioni sistemiche e sepsi da BCG, specie se non trattate prontamente, possono sfociare in insufficienza multi-organo (3, 5, 6). L'insorgenza di tossicità sistemica severa può verificarsi anche dopo anni dall'ultima somministrazione di BCG (3).…”