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INTRODUCTIONIntravesical Bacillus Calmette-Guerin (BCG) therapy is the standard adjuvant treatment for non-muscle invasive bladder carcinoma (NMIBC) with carcinoma in situ, in addition to tumour resection. We aimed to study BCG complications that preclude adequate treatment of NMIBC in an Asian population.METHODSThis retrospective study was conducted using a large, prospectively maintained bladder cancer database. 336 patients received intravesical BCG for bladder cancer in our institution between 2004 and 2016, with an average follow-up of 63 months.RESULTSThe study included 258 (76.8%) male and 78 (23.2%) female patients. Median age at diagnosis of bladder cancer was 69 (range 17-94) years. Median number of BCG instillation was 6 (range 1-27). 52 (15.5%) patients received maintenance therapy. The most common complications included urinary tract infection with or without sepsis (n = 18, 5.4%), haematuria (n = 9, 2.7%) and acute urinary retention (n = 4, 1.2%). 93.3% of the patients with complications presented early, within one month of completion of therapy. 22 out of 30 complications were Clavien-Dindo grade ≤ 2. 10 (33.3%) patients were admitted to hospital because of BCG-related adverse effects. The most common reasons for termination were urosepsis (2/30, 6.7%) and acute urinary retention (2/30, 6.7%). Patients aged ≥ 80 years at diagnosis were at higher risk of developing BCG-related complications (19.0% vs. 7.5%, p = 0.01).CONCLUSIONThis retrospective cohort and subgroup study showed that intravesical BCG therapy is well tolerated and has a low incidence of complications even in the elderly and patients with multiple comorbidities.

Intravesical Bacillus Calmette-Guerin and its complications: 12 years of learning experience in a single local institution