Open Access

ARTICLE

Bladder contracture: review for intravesical bacillus Calmette-Guerin complication

A. Hameed, N. Sezian, A. Thwaini

The James Paget University Hospital, United Kingdom
Address correspondence to Mr. Ammar Hameed, Clinical Research Registrar (Cancer institute), Barts and the London NHS Trust, Urology Department, 7^th Floor, John Harrison House, Royal London Hospital, Whitechapel, London, E1 1BB

Canadian Journal of Urology 2007, 14(6), 3745-3749.

Abstract

Introduction: We are reporting a case of bladder contracture post intravesical bacillus Calmette-Guerin (BCG) therapy; to our knowledge only two cases were reported. We present the clinical history/presentation, investigation and the outcome of the treatment. Approximately 75%-85% of patients with bladder cancer present with disease confined to the mucosa (stage Ta-CIS) or submucosa (stage T1). The management of non-muscle invasive bladder cancer has become more complex with regard to initial investigation, treatment and follow-up. In high-grade tumors, BCG therapy has proven to be superior to intravesical chemotherapy. BCG therapy prevents, or at least delays, tumor progression.
Methods and results: A case of high grade superficial bladder cancer treated with intravesical BCG which has successfully cleared her bladder cancer nevertheless has led to bladder contracture for which case she may need bladder reconstruction/augmentation surgery if she remained disease free added to her psychological and social effects on her life.
Conclusion: Although BCG is considered a very effective treatment; consensus exists that not every patient with superficial bladder cancer should be treated with BCG due to its increased risk of toxicity. Ultimately, the choice of treatment will depend upon the patient's risk of recurrence and progression. Assuming that maintenance therapy is necessary for optimal efficacy, the issue of BCG toxicity becomes more relevant. Due to the more pronounced side effects of BCG compared to intravesical chemotherapy, reluctance still exists about BCG use. However, with increased experience in applying BCG, the side effects now appear to be less prominent and few. Serious side effects are encountered in less than 5% of patients and this case carries one of the rarest, yet drastic, side effects of intravesical BCG.

---

Keywords

---